Pushpa Sirichand, Razia Mustafa Abbassi, Chandra Mandho Das, Nasreen Jatoi.
Urinary tract injuries during gynecological and obstetric practice.
J Surg Pak Jan ;10(3):14-6.

Objective: To determine the number and type of urinary tract injuries encountered in gynecological and obstetrical surgical procedures, so that emphasis can be placed on prevention, early recognition and management of such complications. Study design: Descriptive study. Place and duration: The Department of Obstetrics and Gynecology unit III, Liaquat University Hospital Hyderabad, from 1st March 2000 to February 2004. Patients and Method: It was a case series descriptive study on patients who had obstetric intervention such as instrumental deliveries, caesarean sections, caesarean hysterectomies and gynaecological operations such as abdominal and vaginal hysterectomies, laparotomies, Manchester repair operations and operations for vaginal stenosis. The case records of all the patients who suffered urinary tract injuries were reviewed for predisposing factors location and type of injury, time and method of reorganization and management. Results: During study period 742 major gynecological surgical operations and 2455 major obstetrical operations were performed. There were 12 cases of urinary tract injuries involving bladder, urethra and ureters. Five injuries were documented in 742 gynecological and 7 in 2455 obstetrical procedures. Nine were bladder injuries; two were urethral injuries and one ureteric. The incidence of bladder, urethral and ureteric injuries in gynecological surgery was 0.9%, 0.13% and 0.13% respectively, whereas in obstetric surgery the incidence of bladder, urethral and ureteric injury was 0.24%, 0.04% and 0% respectively. The overall incidence of urinary tract injuries was 0.85 per 1000 deliveries and 3 per 1000 caesarean sections. All the injuries were recognized and managed intraoperatively. 11 patients recovered well and one developed vesicovaginal fistula. Conclusion: Our study concludes that urinary tract injuries are not rare in obstetrical and gynaecological practice. These are due to delayed referral of patients, poor surgical monitoring facilities, improper training and supervision of postgraduate trainees. Prevention, early recognition and prompt treatment of these injuries especially in high-risk patients can reduce the incidence and its related morbidity.

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