English

Abstract

To review the frequency of iatrogenic urological injury during obstetric and gynaecological operations carried out between January 2009 to January 2013 at Government Medical College, Haldwani. Each case was reviewed for predisposing factors, location, type of injury, time of injury, method of recognition and management. 12 injuries were documented in 1063 gynaecological procedures and 3079 obstetric procedures. All were bladder injuries and occurred while separating the bladder. Pelvic adhesions was the most common factor. INTRODUCTION: The reproductive and urinary tracts in women are closely related anatomically and embryologically. Injury to the urinary tract involves injury to the ureters, bladder and urethra (1). The overall rate of urinary tract injury associated with pelvic surgery in women is associated with pelvic surgery in women is approximately 1% (2). Bladder injury is more common than ureteral injury (3). However, the exact incidence of these injuries is difficult to ascertain. Urological injuries in gynaecological surgeries result due to difficult surgery, active infection, endometriosis, enlarged uterus, previous pelvic surgery, pelvic adhesions, ovarian neoplasms, distorted pelvic anatomy, cervical fibroids, broad ligament fibroids, tubo-ovarian mass, advanced malignancies, previous surgery. Such a history should caution on risk of injury and suggest for further preoperative evaluation (4, 5). Diagnosis of urological injuries can be made intraoperatively or postoperatively. Majority of bladder injuries are diagnosed intraoperatively. Intraoperative identification of urological injuries enables prompt repair and is associated with decreased morbidity.