Urologic Complications of Obstetrico-gynecologic Surgery: Experience from National Taiwan University Hospital

Abstract

This retrospective study examined urologic complications of obstetrico-gynecologic surgery managed at our department from January 1984 to December 1997. Each patient was reviewed for her original diagnosis, operative parameters, types and locations of injury, time of recognition, and methods of repair. Patients of matched diagnosis, age, and surgery with no complication were randomly chosen as the control groups to evaluate possible predisposing fac-tors. Among the 109 cases included, 8 were obstetric patients, 49 received radical hysterectomy and pelvic lymph node dissection (PLND), 42 had a simple hysterectomy, 6 received operative laparoscopic procedures, 2 had salpingectomy, and 2 received excision of a periurethral abscess. There were 120 events of urologic complications in these 109 cases, including vesicovaginal fis-tulae (32cases), intraoperatively recongnized injury to the urinary bladder (3cases), uretero-vaginal fistulae (27cases), intraoperatively recognized injury to the ureter (9cases), unilateral ureteral stricture (26cases), bilateral ureteral obstruction (11cases), voiding dysfunction (11cases), and urethrovaginal fistulae (lease). The time and symptoms of presentations and the management of each type of complication are described in detail. When compared with the control cases, the patients receiving radical hysterectomy and PLND with complications had more intraoperative blood loss (p＜0.01); and patients receiving simple abdominal hysterectomy with complications had longer operation time and more blood loss (both p＜0.01). Our series is unique in that a high incidence of ureteral obstruction was disclosed, and because radical hysterectomy played an very important role in causing urological complications. These 2 issues were not em-phasized in previous relevant literature.