Lower urinary tract injuries diagnosed after hysterectomy: Seven‐year experience at a cancer hospital

Abstract

The aim of this study was to determine the incidence, patterns of development and treatment outcomes of lower urinary tract injuries (LUTI) after hysterectomy. A retrospective analysis was conducted on 1443 hysterectomy cases (678 total laparoscopic hysterectomies, 65 laparoscopic radical hysterectomies, 455 total abdominal hysterectomies and 245 radical hysterectomies). LUTI diagnosed intraoperatively were excluded. The incidence of post-hysterectomy LUTI was 0.8% (11/1443). LUTI were more commonly associated with laparoscopic hysterectomies (1.1%) than hysterectomies performed via laparotomy (0.4%). Amongst 11 patients with LUTI, six had gynecological malignancies. Ureteral and bladder injuries were identified in eight and three patients, respectively; one patient had bilateral ureteral injuries. Most of the cases involving post-hysterectomy LUTI developed within 2-4 weeks. The high incidence of LUTI following laparoscopic hysterectomies, and the time of development after hysterectomy, are suggestive of electrocautery injuries rather than physical trauma as the cause of delayed diagnosis of LUTI. Four of five surgeons experienced LUTI in the first 10 hysterectomies. Proper training and guidance by an experienced attending physician are required when first performing hysterectomies. The incidence of post-hysterectomy LUTI was 0.8%. Five of the nine ureteral injuries and one of the three bladder injuries healed after double-J stents and a Foley catheter were inserted, respectively.