IATROGENIC URINARY TRACT INJURY IN OBSTETRIC AND GYNECOLOGICAL PROCEDURES: FIVE-YEAR- EXPERIENCE FROM TWO UNIVERSITY HOSPITALS

Abstract

Background: Owing to improvements in gynecological and obstetric techniques that help to prevent urinary tract injury and immediate recognition and repair of any injury occur, long-term complications are less frequent nowadays. Aim of the Work: To evaluate the role and importance of the presence of a urogynecology team in management of Obstetrics and gynecology cases with high risk of urological injuries for preoperative assessment, intra operative management and post operatively for follow up of cases repaired and cases need late management like cases presented with urinary tract fistulae. Patients and Methods: This retrospective study included all patients with genitourinary injuries following obstetric and gynecologic procedures that were treated at the Department of Urology and department of obstetrics and gynecology, Al-Hussein and Sayed Galal University Hospitals during the past 5 years. All cases with urological injuries were managed by urogynecological team of urology department of Al-Azhar Cairo University. Results: In our study we detected 97 cases. We found 35 patients (36.1 %) were complicated in gynecological procedures while 62 patients (63.9%) were complicated in obstetric procedures, As regard our study three types of injuries were detected ureteric injuries (8.2%), bladder injuries (27.8%) and fistula formation (63.9%). Conclusion: Complicated gynecological and obstetric procedures with high risk of urological injuries should be managed in collaboration between obstetric ,gynecological and urogynecological teams for: preoperative assessment or intervention like; endoscopic stent fixation in cases with risk of injury, early detection of any urological injuries in all gynecological and obstetric procedures, early intervention and management of all types of urological injuries and follow up all managed patients and assessment and preparation of all cases need late repair.