Iatrogenic urological injuries complicating obstetric and gynaecological procedures.
BACKGROUND
Urinary tract injuries are known complications of pelvic surgeries. Although a few instances have been noted, they remain a source of great concern to surgeons due to their associated morbidity and occasional mortality. We report our experience with the management of iatrogenic urological injuries that complicated obstetric and gynaecological surgeries over a five-year period.


METHODS
We reviewed all cases of urological injuries managed in our unit that were deemed to be of obstetric and gynaecological origins within the study period.


RESULTS
A total of 16 patients were identified as having iatrogenic urological injuries following obstetric and gynaecological surgeries. Only four patients presented early. Five patients had injuries to the bladder, while 12 had ureteric injuries; one of the 16 patients had both types of injuries. Seven cases of ureteric injuries affected only the left ureter, while three were bilateral and two affected the right ureter. One patient with a vesicovaginal fistula (VVF) was successfully managed by urethral catheter drainage alone. Three patients had transabdominal repair of the VVF, while ten had ureteroureterostomy and one had diversion procedure. Simple nephrectomy was performed for one patient with a non-functioning kidney.


CONCLUSIONS
Iatrogenic urological injuries are still common in our environment. In order to reduce the risk of injury, adequate preoperative preparation is recommended and meticulous surgical technique based on proper understanding of the anatomy of the urogenital system should be practised by the surgeon.
Urology Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City 300001, Nigeria. dredbaris@gmail.com
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Obarisiagbon
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Olagbuji
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Onuora
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Oguike
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Ande
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D008875:Middle Aged; D009549:Nigeria; D013513:Obstetric Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D011247:Pregnancy; D011788:Quality of Life; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D014513:Ureter / Q000293:injuries* / Q000601:surgery; D001743:Urinary Bladder / Q000293:injuries* / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000209:etiology / Q000601:surgery; D055815:Young Adult