Scrutinization and management of urological complications attributed to obstetrics and gynecological surgery

Abstract

Aim: To review iatrogenic urological injuries due to obstetric and gynecological surgeries treated in the urology and gynecology department analyzing urinary tract anatomy, etiologic factors, diagnosis, treatment, and outcomes. Materials and methods: We reviewed all cases of urological injuries managed in our institution from January 2009 to December 2016 which were associated with obstetric and gynecological procedures. Results: Eighty-one patients were treated in the department during our study period. The most commonly injured organ was the bladder in 64.7% followed by ureter in 31.8%. Intraoperative diagnosis was made in 11.1% (9) cases, whereas 88.89% (72) cases were diagnosed postoperatively. Out of 81 cases, 66.7% (54) patients succumbed to urologic injuries as a result of gynecological procedures, while 33.3% (27) cases were due to obstetrical procedures. Vesicovaginal fistula (VVF) was the most common sequel followed by ureterovaginal fistula (UVF) in 42 (51.8%) and 15 (18.5%) cases, respectively. VVF combined with UVF and rectovaginal fistula were seen in 2 cases each. Although rare among various urogenital fistulas, vesicouterine fistula was encountered in three (3.7%) cases. All cases were managed with open or laparoscopic surgery with success in all but two patients. Conclusion: Complex gynecological procedures are gradually emerging as an important cause of urological injuries, second to obstetrical causes. Intraoperative detection and correction takes a vital part in determining structural integrity of the tissue and eliminating misery of the patient. Delayed diagnosis and improper treatment may result in severe complications. Clinical significance: Thorough knowledge of pelvic anatomy, meticulous surgical technique, early diagnosis of injury, and collaboration with a urologists in complex cases is required to reduce urological complications in obstetrics and gynecological procedures.