Urological trauma after gynecological and obstetric surgeries.
OBJECTIVE
Gynecological and obstetric surgeries are not uncommon causes of iatrogenic injury of the urinary tract. Herein, we retrospectively report our experience with these injuries over the last 18 years.


METHODS
Between 1985 and 2003, 120 females (mean age 34.2+/-13.7 years) were included in this study. The types of injury were as follows: vesicovaginal fistula, n=90; ureterovaginal fistula, n=14, ureteric ligation, n=13, vesicouterine fistula, n=2; and ureterouterine fistula, n=1. Definitive repair of such injuries was performed in all cases, including 10 cases of recurrent vesicovaginal fistulae which were treated by means of augmentation cystoplasty or urinary diversion. All patients were evaluated regarding the time and type of surgical intervention and early and late postoperative complications, including failure of primary repair.


RESULTS
Of the 80 cases of vesicovaginal fistulae treated with definitive repair, 12 (13.3%) showed recurrence of the fistula. Early ureteric deligation and early or delayed ureteroneocystostomy or ureteric replacement were successful in all cases with ureteric injury. There was no loss of kidney function following the trauma or its repair.


CONCLUSIONS
It is mandatory for gynecologists and obstetricians to pay careful attention to the anatomy of the urinary tract in order to avoid its iatrogenic injury. Endourologic means were successful in enabling first aid management of some of these injuries. Early exploration is indicated in cases of ureteric obstruction that present early after trauma. Augmentation cystoplasty, urinary diversion or ileal replacement are indicated in only a few cases.
El-Tabey
Nasr A
NA
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. n_eltabey@yahoo.com
Ali-El-Dein
Bedeir
B
Shaaban
Atallah A
AA
El-Kappany
Hamdy A
HA
Mokhtar
Alaa A
AA
El-Azab
Mohamed
M
Kheir
Albeir A
AA
D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease; D008875:Middle Aged; D013513:Obstetric Surgical Procedures / Q000009:adverse effects*; D012008:Recurrence; D012189:Retrospective Studies; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery; D014551:Urinary Tract / Q000293:injuries* / Q000601:surgery; D014624:Vaginal Fistula / Q000209:etiology / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000209:etiology* / Q000601:surgery