Urinary tract injury in laparoscopic-assisted vaginal hysterectomy.
OBJECTIVE
To evaluate the incidence and characteristics of urinary tract injury after laparoscopic-assisted vaginal hysterectomy (LAVH).


METHODS
A retrospective study that evaluated all cases of urinary tract injury at the time of LAVH in an 11-year period. Parameters including surgical indication, site of injury, time of diagnosis, method of treatment, and long-term follow-up were analyzed. (Canadian Task Force classification II-2).


METHODS
Tertiary care university hospital.


METHODS
A total of 38 urinary tract injuries were found in 7725 LAVH.


METHODS
LAVH and repair of urinary tract injuries with transvaginal or transabdominal approach.


RESULTS
The incidence of urinary tract injury after LAVH was 4.9/1000 procedures: 3.9/1000 for urinary bladder injury and 1.0/1000 for ureteral injury. Prior cesarean section was the most common risk factor for bladder injuries. Ninety-six percent (29/30) of urinary bladder injuries were detected and treated during surgery. Half (4/8, 50%) of the ureteral injuries were identified during surgery. Of the 38 complications, 28 (75.7%) occurred in surgery.


CONCLUSIONS
Most urinary tract injuries in LAVH were identified during surgery and are associated with the surgeon's experience. Bladder injury can be repaired either transvaginally or abdominally; ureteral injury can be repaired abdominally.
Soong
Yung-Kuei
YK
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan. yks@cgmh.org.tw
Yu
Hsing-Tse
HT
Wang
Chin-Jung
CJ
Lee
Chyi-Long
CL
Huang
Hong-Yuan
HY
D000046:Academic Medical Centers; D000328:Adult; D002681:China; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects*; D019300:Medical Errors / Q000009:adverse effects* / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies; D014513:Ureter / Q000293:injuries*; D001743:Urinary Bladder / Q000293:injuries*