Bladder and Ureter Injuries During Obstetric and Gynecological Procedures

Abstract

Background: Urological injuries are an important matter of a gynecologist especially during hysterectomy and Caesarean section. These complications, although rare, can lead to morbidity and mortality  and also can create worry and psychosocial concerns for couples. The most common site liable for injury are bladder and distal ureter .
Objective:The objective of this study is to find out the frequency and kind of urological injuries in obstetric and gynecological procedures.
 Patients and method: This Prospective case series study ,performed at Al- Batool maternity teaching hospital, Mosul, Iraq during the period from January 2013 to July 2014 , The study include 21 patients who underwent obstetric and gynecologic  surgeries    that  complicated  with  Iatrogenic  Bladder  &  Ureter Injury (IBI&IUI).All patient accessed with focus history and examination , Intraoperative and postoperative bladder and ureter injury was recorded and studied.
Results:  The  results  of  the  study  showed  that  out  of  11,861  obstetric& gynecological (OBG)  procedures 21(0.18%) patients have  urological injuries. The patients  ages ranged between  23–55 years [mean ±STD (36.47±7.69 years)] and patients parity 0–12[mean ±STD (4.33±2.56)]. 
   Of the 21 patients who have injury  ,17 patients (80.95%) due to obstetrical procedures    &  4  patients  (19.05%)  due  to  gynecological    procedures 
.13(61.9%)cases were emergency VS 8(38.1%) cases  were elective . Among the obstetric procedure 16 (94.11 %) had previous caesarean sections with 11(64.70 %) had more than one scar. Pelvic adhesion  of severe   type was found in 13 (61.9%)  patients. Morbidly adherents placenta in the  form of accreta , percreta occurred in 5 patients (29.4%)  
   The frequency of urological injury (17 case) among all obstetric operastion (11344 case)  was 0.15% while the frequency of urological injury(4 cases) among all gynecological operation (517 case )was 0.77% . 50% of bladder injury are of grade 3.  
Conclusion and recommendations : Iatrogenic ureteric and bladder injuries from obstetric and gynecologic surgeries  though uncommon but are liable to occur. Bladder injury occurred more commonly than ureteral injury ,Possible injury to the urinary tract should be discussed with all patients undergoing a surgical intervention, as it is a recognized complication.