Urological injuries following Obstetricaland Gynecological Surgeries.|
Sebukoto, H.R.; Semwaga, E. & Rugakingila, R.A.
Background: Gynaecological operations have been reported to be associated with
injuries to the ureter. This study was aimed at reviewing the urological
complications resulting from obstetric and gynaecological surgeries in respect to
frequency, clinical presentations, and time of diagnosis. The study was undertaken
at Departments of Obstetrics, Gynecology and Urology at Kilimanjaro Christian
Medical Centre Tanzania from January 2009 to December 2014.
Methods: In this 6-year retrospective study, 11219 obstetrical and gynecological
surgeries were performed. All patients who sustained urological injuries were
reviewed and entered into a data sheet before analyzing their frequency, clinical
presentation and the time of presentation.
Results: Of the 9221 obstetrical and 1998 gynecological surgeries performed, 105
(0.94%) were sustained urological injuries. A total of 82 patients had VVF (78%),
18 (17.2%) had ureteral injury, 4 (3.8%) patients had bladder injury only, and 1
patient (1%) had both VVF and Ureteral Injury. With respect to injury rate by
specific procedure, caesarean section in obstetric surgeries contributed to 36
patients (34.3%) with urological injuries, whereas TAH was the leading
gynecological procedure which contributed to 18 patients (17.1%) with urological
injuries. All patients with VVF had history prolonged labor and presented with
persistent urine leakage per vagina (urine incontinence). The time of diagnosis to
most of the patients was more than 48 hours especially to patients with VVF. There
were no patients with urethral injury.
Conclusion: Obstetric surgeries have shown to contribute to a higher number of
urological injuries as compared to gynecological surgeries. Both VVF and ureteric
injuries being the most common in obstetrics and gynecologic surgeries
respectively have great economic and social impacts not only to the patients, but
also the surrounding community and the country as a whole. Late presentation and
diagnosis increases the risks of further complications. Early presentation, diagnosis
and urologic intervention is important for the better outcomes.