Abstract
Key message
Ureteral injuries are often associated with complications and risk of fistula especially in case of malignancy. Length of catheterization should be reconsidered according to the injury.
Abstract
Purpose
Iatrogenic urinary tract injuries are potential complications of gynecologic and obstetric surgery. Our aim was to describe suture type and size, length of urethral catheterization, length of hospitalization, reoperation rate, follow-up, and impact on quality of life following iatrogenic bladder and ureteral injury.
Methods
In total, 81 women met inclusion criteria. Bladder injuries included 55 women, ureteral injuries in 23 women, and three women had bladder and ureteral injuries.
Results
Most bladder injuries were managed by a two-layer suture followed by transurethral catheterization for 11.4 days (95% CI 9.1–13.6). The most frequent suture type was 3.0 Vicryl in all subgroups. In total, 30.4% of ureteral injuries were managed by neoimplantation followed by ureteral stenting for 38.0 days (95% CI 22.0–54.0) and transurethral catheterization for 16.9 days (95% CI 5.3–28.4), or by ureteral stenting for 46.7 days (95% CI 31.5–61.2) and transurethral catheterization for 6.25 days (95% CI 1.0–13.5).
Altogether, 25 (30.9%) women underwent a reoperation mostly due to ureteral injury (68%). In total six women developed a fistula, of whom five had malignant surgery.
Multiple linear regression showed a statistically significant increased median length of urethral catheterization when the duration of surgery increased.
Conclusions
Our study demonstrates a high reoperation rate, and a high fistula rate in case of malignancy. Length of catheterization was high even in case of benign surgery, however, only one woman developed a fistula in the benign group, suggesting a reduction in catheterization length.
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References
Wong JMK, Bortoletto P, Tolentino J, Jung MJ, Milad MP (2018) Urinary tract injury in gynecologic laparoscopy for benign indication: a systematic review. Obstet Gynecol 131:100–108
Aydin C, Mercimek MN (2020) Laparoscopic management of bladder injury during total laparoscopic hysterectomy. Int J Clin Pract 74:e13507
Oliphant SS, Bochenska K, Tolge ME, Catov JM, Zyczynski HM (2014) Maternal lower urinary tract injury at the time of cesarean delivery. Int Urogynecol J 25:1709–1714
Gilmour DT, Das S, Flowerdew G (2006) Rates of urinary tract injury from gynecologic surgery and the role of intraoperative cystoscopy. Obstet Gynecol 107:1366–1372
Yossepowitch O, Baniel J, Livne PM (2004) Urological injuries during cesarean section: intraoperative diagnosis and management. J Urol 172:196–199
Esparaz AM, Pearl JA, Herts BR, LeBlanc J, Kapoor B (2015) Iatrogenic urinary tract injuries: etiology, diagnosis, and management. Semin Intervent Radiol 32:195–208
Adelman MR, Bardsley TR, Sharp HT (2014) Urinary tract injuries in laparoscopic hysterectomy: a systematic review. J Minim Invasive Gynecol 21:558–566
Sahai A, Ali A, Barratt R, Belal M, Biers S, Hamid R et al (2021) British Association of Urological Surgeons (BAUS) consensus document: management of bladder and ureteric injury. BJU Int 128:539–547
Rahman MS, Gasem T, Al Suleiman SA, Al Jama FE, Burshaid S, Rahman J (2009) Bladder injuries during cesarean section in a University Hospital: a 25-year review. Arch Gynecol Obstet 279:349–352
Chamsy D, King C, Lee T (2015) The use of barbed suture for bladder and bowel repair. J Minim Invasive Gynecol 22:648–652
Chan JK, Morrow J, Manetta A (2003) Prevention of ureteral injuries in gynecologic surgery. Am J Obstet Gynecol 188:1273–1277
Rao D, Yu H, Zhu H, Duan P (2012) The diagnosis and treatment of iatrogenic ureteral and bladder injury caused by traditional gynaecology and obstetrics operation. Arch Gynecol Obstet 28:763–765
eBoks. e-boks.com. https://www.e-boks.com/danmark/en/what-is-e-boks/ Accessed 11.10.2021.
Guldberg R, Brostrøm S, Hansen JK, Kærlev L, Gradel KO, Nørgård BM et al (2013) The Danish urogynaecological database: establishment, completeness and validity. Int Urogynecol J 24:983–990
Clausen J, Gimbel H, Arenholt LTS, Løwenstein E (2021) Validity and reliability of two Danish versions of the ICIQ-UI SF. Int Urogynecol J 32:3223–3233
von Elm E AD, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2021) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. equator-network. https://www.equator-network.org/reporting-guidelines/strobe/. Accessed 27 Sep 2021.
Gungorduk K, Asicioglu O, Celikkol O, Sudolmus S, Ark C (2010) Iatrogenic bladder injuries during caesarean delivery: a case control study. J Obstet Gynaecol 30:667–670
Phipps MG, Watabe B, Clemons JL, Weitzen S, Myers DL (2005) Risk factors for bladder injury during cesarean delivery. Obstet Gynecol 105:156–160
Naicker S, Naidoo TD, Moodley J (2020) Obstetric-associated lower urinary tract injuries: a case series from a tertiary centre in a low-resource setting. Case Rep Womens Health 27:e00218
Ebert JF, Huibers L, Christensen B, Christensen MB (2018) Paper- or web-based questionnaire invitations as a method for data collection: cross-sectional comparative study of differences in response rate, completeness of data, and financial cost. J Med Internet Res 20:e24
Acknowledgements
The authors would like to thank Open Patient data Explorative Network for the possibility to register and store data in the database. Furthermore, for statistical advice.
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AJ: Project development, data collection, data analysis, and manuscript writing; MR: Protocol/Project development, manuscript writing.
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Jensen, AS., Rudnicki, M. Iatrogenic bladder and ureteral injuries following gynecological and obstetric surgery. Arch Gynecol Obstet 307, 511–518 (2023). https://doi.org/10.1007/s00404-022-06800-0
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DOI: https://doi.org/10.1007/s00404-022-06800-0