Urinary tract injuries during pelvic surgery: incidence rates and predisposing factors.
OBJECTIVE
To review the cases of urinary tract injury following major pelvic surgery that were treated in our hospital over the last 12 years, in relation to possible predisposing factors and incidence rates of injury arising in various surgical procedures.


METHODS
From 8,824 major gynecological operations performed in our department, 29 cases of intraoperative urinary tract injury were found. Thirty eight patients visited the urology department during the same period for the management of urogenital fistula following pelvic surgery. Parameters that were examined included type of urinary tract injury, indication for surgery, type of operation, coexisting pathological conditions, past history of pelvic surgery or pelvic irradiation, and the delay in the recognition and management of the urinary tract injury.


RESULTS
The overall incidence of urinary tract injury in pelvic surgery was 0.33%. The incidence of urinary tract injury in radical hysterectomy was higher than that of total abdominal hysterectomy(0.76 vs 0.26%). Of the intraoperative urinary tract injuries, 48.4% coexisted pelvic pathologies. Of all the cases with urinary tract injury, the most common type of operation was total abdominal hysterectomy (n = 45, 67.2%), and the most common indication was uterine myoma (n = 25, 36.9%). The most common type of urinary tract injury was bladder injury, including bladder laceration and vesicovaginal fistula(n = 57, 76.1%). The frequency of reoperation was found to be lower in patients with a shorter delay in the recognition of the injury (p < 0.05).


CONCLUSIONS
Possible predisposing factors for urinary tract injury are coexisting pelvic adhesion, distortion of normal pelvic configuration, previous irradiation history, previous operation history, and the extent of surgery. In high-risk patients, proper evaluation is needed to avoid urology complications before operation.
Bai
Sang Wook
SW
Department of Obstetrics and Gynecology, Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea. swbai@yumc.yonsei.ac.kr
Huh
Eun Ha
EH
Jung
Da Jung
DJ
Park
Joo Hyun
JH
Rha
Koon Ho
KH
Kim
Sei Kwang
SK
Park
Ki Hyun
KH
D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D019300:Medical Errors / Q000009:adverse effects / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014551:Urinary Tract / Q000293:injuries*