Iatrogenic urologic injuries in pelvic surgeries: a retrospective study

Purpose: To study the incidence of ureter & bladder injuries detected intra-operatively/post operatively following pelvic surgeries in the gynecology and oncology departments of our institution This study describes our experience in the management of ureteric/bladder injuries following pelvic operations and outcome of management of this condition in our local setting.
Methods: This is a retrospective descriptive study of patients with iatrogenic injuries to the ureter and bladder following pelvic surgeries that were managed in our urology department, Government Royapettah Hospital, from September 2016-April 2018. Analysis of the patient diagnosis ,indication for surgery, type of surgery, time at diagnosis of injury, presenting features and the type of management was done.
Results: A total of 12ureteric injuries and 9 bladder injuries were identified out of 299 pelvic surgeries performed in the study period. All bladder injuries were diagnosed and managed intra-operatively.
80% of ureteric injuries were diagnosed post-operatively with fever, flank pain and leakage of urine being the most common presentation. Duration of symptoms ranged from immediate post-op period to upto 6 months after surgery. 45% were diagnosed with ureteric stricture,33% with uretero-vaginal fistula and 22 % were diagnosed intra-operatively. Incidence of ureteric injuries in simple hysterectomy for benign causes was 1.8%, and for wertheim’s hysterectomy for malignancy was 6%. Incidence of ureteric injuries following laparoscopic hysterectomy was 7%. Ureteric injury following APR was found to be 7%. We performed ureteroneocystomy was for 4 cases , boari flap for 2 cases, transuretero-ureterostomy in 1 case, nephrectomy in 1 case and uretero-colonic anastomosis in 1 patient. Post operative complications observed were surgical site infection in 33% and urosepsis in 11% of patients. Mortality was nil.
Conclusions: Laparoscopic and wertheim’s hysterectomy were most commonly associated with ureteric injuries. Meticulous surgical technique as well as identification of the course of the ureter and associated anatomic locations where injury is most likely to occur is important to decrease the risk of ureteric injury. Timely recognition of ureteric injury and its management is associated with good outcome.