title: Disability and litigation from urinary tract injuries at benign gynecologic surgery in Canada.
abstract: OBJECTIVE
  To estimate the prevalence of urinary tract injury and the relative risk of litigation from an injury for benign gynecologic surgery in Canada and to analyze a subset of cases of litigation, determining independent risk factors that predicted medical and legal outcomes.
  
  
  METHODS
  The prevalence of urinary tract injury and the relative risks of litigation from an injury were determined from the national hospital discharge abstract and the national physician malpractice databases. Multiple logistic regression was performed on a subset of litigation cases.
  
  
  RESULTS
  The prevalence of urinary tract injury at benign gynecologic surgery was low (0.33%). If a patient sustained a urinary tract injury, there was a high relative risk of litigation (relative risk 91, 95% confidence interval [CI] 55-158). Patients had a higher chance of major disability after urinary tract injury from hysterectomy for abnormal uterine bleeding (odds ratio [OR] 6.16, 95% CI 1.13-39.01, P = .04), but a lower chance of this being a permanent disability (OR 0.23, 95% CI 0.05-0.96, P = .05). Permanent disability was more likely after an obstructed ureter compared with other types of urinary tract injuries (OR 4.54, 95% CI 1.55-14.88, P = .008). Only 18% of the injuries were recognized intraoperatively. An acute bladder injury was more likely to be recognized intraoperatively than other types of injury (OR 14.98, 95% CI 3.89-57.74, P < .001). No obstructed ureters or urinary tract fistulae were recognized intraoperatively.
  
  
  CONCLUSIONS
  Urinary tract injuries are an uncommon but significant complication from benign gynecologic surgery. Such injuries are associated a high relative risk of litigation.
authors.affiliation: Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada. Catherine.Hamblin@iwk.nshealth.ca
authors.forename: Donna T
authors.initials: DT
authors.lastname: Gilmour
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Baskett
mesh_terms: D000290:Adnexa Uteri / Q000601:surgery; D002170:Canada; D004185:Disability Evaluation; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007431:Intraoperative Complications; D016365:Liability, Legal; D008318:Malpractice / Q000331:legislation & jurisprudence*; D014551:Urinary Tract / Q000293:injuries*