Management of urological injuries following gynecologic and obstetric surgery: A retrospective multicenter study.

Northern clinics of Istanbul Pub Date : 2024-08-01 eCollection Date: 2024-01-01 DOI:10.14744/nci.2024.46403
Ahmet Keles, Ilkin Hamid-Zada, Ozgur Arikan, Gurkan Dalgic, Ali Selim Durmaz, Esra Keles, Ahmet Karakeci, Fatih Bicaklioglu, Hasan Samet Gungor, Kursad Nuri Baydili, Bilal Eryildirim, Eyup Veli Kucuk, Asif Yildirim
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Abstract

Objective: Urinary system injuries may occur iatrogenically during some surgical procedures especially gynecological and obstetrical surgeries. Unfortunately, these injuries can lead to serious complications in patients. In this multicentric study, we aimed to review and report our experiences and results of urinary tract injuries identified during gynecological and obstetrical surgery.

Methods: We included women with urinary tract injuries during gynecological and obstetrical surgeries between January 2018 and October 2023 at four centers. Detailed data collected include patient demographics, surgical details, injury characteristics, diagnostic and treatment methods, timing of injury diagnosis and management reports of the patients. The incidence of bladder and ureter injuries was evaluated and the rate of intraoperative urological consultations was recorded.

Results: In a total of 328 patients with a median age of 47 years (24-90), urinary tract injuries were diagnosed, including 227 (69.2%) iatrogenic bladder injuries (IBI) and 101 (30.8%) iatrogenic ureteral injuries (IUI). These injuries were diagnosed in 299 patients (91.2%) during surgery and in 29 patients (8.8%) after the surgical procedure. We observed intraoperative detection rates of 71.9% for IBI and 28.1% for IUI. IBI (71.9%) was diagnosed significantly more frequently than IUI (28.1%) (p=0.001). Cesarean section resulted in significantly more frequent IBI, whereas tumor debulking surgeries resulted in more IUI (n=52, 56.5%) than the other types of procedures (p<0.001).

Conclusion: Our study provides a comprehensive overview of iatrogenic urological injuries during gynecological and obstetrical surgeries. Although the bladder is the most frequently injured organ during gynecological and obstetric surgeries, early diagnosis and urological intervention are mandatory to prevent delayed complications. Surgeons must have a thorough understanding of the pelvic anatomy and appropriate surgical techniques to prevent iatrogenic injuries during surgery and ensure timely diagnosis and treatment of urinary tract injuries.

妇产科手术后泌尿系统损伤的处理:一项多中心回顾性研究。
目的:在某些外科手术(尤其是妇产科手术)中可能会出现泌尿系统损伤。不幸的是,这些损伤可能会导致患者出现严重的并发症。在这项多中心研究中,我们旨在回顾和报告在妇产科手术中发现的尿路损伤的经验和结果:我们纳入了 2018 年 1 月至 2023 年 10 月期间在四个中心进行妇产科手术时出现尿路损伤的女性患者。收集的详细数据包括患者人口统计学特征、手术细节、损伤特征、诊断和治疗方法、损伤诊断时间以及患者的管理报告。评估了膀胱和输尿管损伤的发生率,并记录了术中泌尿科会诊率:结果:共有 328 名中位数年龄为 47 岁(24-90 岁)的患者被诊断出泌尿道损伤,其中包括 227 例(69.2%)先天性膀胱损伤(IBI)和 101 例(30.8%)先天性输尿管损伤(IUI)。299名患者(91.2%)在手术中被诊断出这些损伤,29名患者(8.8%)在手术后被诊断出这些损伤。我们观察到,IBI 和 IUI 的术中检出率分别为 71.9% 和 28.1%。IBI(71.9%)的诊断率明显高于 IUI(28.1%)(P=0.001)。剖腹产导致的 IBI 发生率明显高于其他类型的手术,而肿瘤剥除手术导致的 IUI(n=52,56.5%)则高于其他类型的手术(p结论:我们的研究全面概述了妇产科手术中的泌尿系统先天性损伤。虽然膀胱是妇产科手术中最常受伤的器官,但必须及早诊断并进行泌尿科干预,以防止延迟并发症的发生。外科医生必须充分了解骨盆解剖结构和适当的手术技巧,以防止手术中的先天性损伤,并确保及时诊断和治疗泌尿道损伤。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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