Management of Urinary Tract Injuries by Laparoscopy: Our Experience.

Objectives: To investigate the underlying risk factors, clinical value, usefulness, and outcome of laparoscopic management of urinary tract injuries.

Materials and methods: A retrospective cohort study including 25 patients of a case of urinary tract injuries in duration from January 1, 2015 to May 31, 2023 was conducted at tertiary care hospital from Central India after the approval from the institutional ethics committee was obtained. All the cases were managed by laparoscopic route by a single surgeon with more than 15 years of experience.

Results: A total of 25 patients were operated for urinary tract injuries at our hospital during the study period. All cases were managed laparoscopically. All patients showed complete recovery. The major risk factors for injury were adhesions, previous lower segment cesarean section, and endometriosis. The most of injuries occurred during hysterectomy, with few of them during cesarean section. Ten cases of bladder injuries were identified intraoperatively and managed by bladder repair in two layers. Four cases with ureteric injuries were managed by ureteric catheterization. In ureterovaginal fistula group, 5 cases were managed by ureteric re-implantation uretero-neocystotomy whereas, 1 case was managed by ureteric catheterization. Five cases with vesicovaginal fistula (VVF) were managed by VVF repair.

Conclusion: The sound anatomical knowledge of pelvic anatomy, risk factors associated with urinary tract injury, and meticulous operative procedure is important for the prevention and early identification of the injuries if any to minimize the morbidity postoperatively. With technical advances and surgical expertise urinary tract injuries can be managed by laparoscopy with excellent outcome.