Iatrogenic Urinary Tract Injuries Research Articles

Characteristics and management of iatrogenic urinary tract injuries in teaching hospital: A single-centered study.

Despite its rarity, iatrogenic urinary tract injury can cause severe morbidity and mortality. The purpose of this study was to determine the frequency of urinary tract injuries caused by medical treatment in a hospital in Medan, Indonesia. This retrospective descriptive study was conducted at H. Adam Malik General Hospital and Universitas Sumatera Utara Hospital in Medan from March to August 2022. Medical data of individuals who had iatrogenic urinary tract injuries in a Medan teaching hospital from 2018 to 2022 were obtained using total sampling. SPSS version 25 was utilized to analyze patient characteristics, the type of surgery, urinary tract injuries, and urologic procedures. There were 11 ureteral injuries and 23 bladder injuries in 32 iatrogenic urinary tract injuries. The average age of the patients was 40.5 ± 13.3. Patients who received obstetrical care had the highest rate of iatrogenic urinary tract injury (56.3%), followed by patients who received gynecological care (21.9%) and surgical care (21.9%). The procedure most likely to cause iatrogenic urinary tract injury was hysterectomy (40.6%). Bladder rupture (65.5%) and ureteral transection (28.1%) were common types of iatrogenic bladder and ureteral injuries. Majority of iatrogenic urinary tract injuries were treated with bladder repair (68.8%). Obstetrical and gynecologic procedures, especially hysterectomy, were the most common causes of iatrogenic urinary tract injury; bladder repair was the most common treatment. Iatrogenic urinary tract injury is best managed by knowing the anatomical position of the urinary tract inside the operative field.

Urological injuries following gynecologic surgery: clinical manifestations, diagnosis and management

Iatrogenic urinary tract injury constitutes a rare but serious complication of gynecologic surgery, occurring in 0.3% to 1.5% of all procedures. Delayed diagnosis and repair are associated with increased postoperative morbidity, mortality and a long-term negative impact on the quality of life. Intraoperative detection of urinary tract injuries allows for prompt repair, facilitates management and speeds up recovery. Bladder injuries are 3 times more common than ureteral injuries, and usually are recognized and repaired immediately with minimal complications. Undetected ureteral injuries lead to severe postoperative complications such as the formation of genitourinary fistulas, sepsis, renal loss and death. In this review we aim to describe the postoperative clinical manifestations, the diagnostic methods and therapeutic strategies for the management of urinary tract injuries, whether in the acute or delayed setting, in an effort to reduce the potential impact of subsequent complications to both patient and surgeon. Timely and effective repair of urinary tract injuries is critical to improve patient outcome, mitigate litigation risk, and allow an uneventful postoperative recovery in a careful manner.

A critical appraisal of recognition and management of iatrogenic urinary tract injuries: Where do we stand? (1133)

A critical appraisal of recognition and management of iatrogenic urinary tract injuries: Where do we stand? (1133)

Role of interventional radiology in the management of iatrogenic urinary tract injury: the factors affecting the outcome

To evaluate the efficacy of interventional radiological (IR) procedures in iatrogenic urinary tract injury and investigate the factors affecting the outcome. Fifty-eight patients (21 male) with a mean age of 50.3 ± 15.8 years referred for iatrogenic urinary tract injury were enrolled in this study. Technical success was defined as (i) successful placement of a nephrostomy catheter within the renal pelvis and/or (ii) successful antegrade ureteral stent placement (double J stent) between the renal pelvis and bladder lumen. Complete resolution was defined as maintained ureteral patency without an external drain and ureteral stent. The factors that may affect complete resolution [ureteral avulsion, ureterovaginal fistula (UVF), history of malignancy/radiotherapy, and time to IR management] were also investigated. The receiver operating characteristic analysis was performed to estimate the cut-off time point for the IR management timing affecting complete resolution. The technical success rate for nephrostomy and ureteral stent placement was 100% (n = 58/58) and 78% (n = 28/36), respectively. In 14 patients, non-dilated pelvicalyceal systems were evident. In 18 patients, no further intervention after percutaneous nephrostomy was performed due to (i) poor performance status (n = 6) and (ii) reconstruction surgery upon clinicians' and/or patients' request (n = 12). Reconstruction surgery was required in 11 of the remaining 40 patients due to failure of percutaneous treatment (n = 11/40, 27.5%). In six of the patients, ureteral stents could not be removed due to the development of benign ureteral strictures (n = 6/40, 15%). Our complete resolution rate was 57.5% (n = 23/40). Age, gender, type of surgery (endoscopic or open), side and location of the injury did not statistically affect the complete resolution rate. The presence of ureteral avulsion, history of malignancy and radiotherapy individually or in combination significantly affected the complete resolution rate negatively. The presence of UVF also had a negative effect on the complete resolution rate; however, it did not reach statistical significance. Delayed intervention was also a significant factor related to lower complete resolution. The optimal cut-off point of the time interval for favorable clinical outcome was found to be 0–19th day following the surgery. IR procedures are safe and effective in the management of iatrogenic urinary tract injuries. Antegrade ureteral stenting should be performed as soon as possible to establish ureteral integrity without the development of stricture.

Iatrogenic urinary tract injuries during obstetric and gynecological operations in Assiut University Women Health Hospital

Iatrogenic urinary tract injuries during obstetric and gynecological operations in Assiut University Women Health Hospital

Iatrogenic bladder and ureteral injuries following gynecological and obstetric surgery.

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. 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. 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. Most bladder injuries were managed by a two-layer suture followed by transurethral catheterization for 11.4days (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 38.0days (95% CI 22.0-54.0) and transurethral catheterization for 16.9days (95% CI 5.3-28.4), or by ureteral stenting for 46.7days (95% CI 31.5-61.2) and transurethral catheterization for 6.25days (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. 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.

Iatrogenic injury of the urinary tract during salvage procedures for pelvic sepsis: Experience of a national referral centre.

This study aimed to determine the incidence, consequences and outcomes of iatrogenic urinary tract injury (IUI) during salvage surgery for pelvic sepsis. Patients who underwent salvage surgery for pelvic sepsis after prior low anterior resection or Hartmann's procedure for rectal cancer were prospectively maintained in a database between 2010 and 2020 and reviewed retrospectively. The primary endpoint was the incidence of IUI. Secondary endpoints were timing of diagnosis (intra- vs. postoperative), reinterventions related to the IUI and healing of IUI. In total 126 consecutive patients were included, and IUI occurred in 13 patients (10%). A ureteric injury occurred in eight patients, bladder injury in four patients and a urethral injury in one patient. All patients with an IUI had radiotherapy as neoadjuvant treatment. The IUI was diagnosed postoperatively in 63% (n= 8/13) with a median duration between surgery and diagnosis of the IUI of 10 days (IQR: 6-15). The median number of reinterventions was five (range 1-31) in the group with a postoperative diagnosis and one (range 0-1) in the group with an intraoperative diagnosis. Four patients required a surgical reintervention, all concerning injuries diagnosed postoperatively. At the end of follow-up, 85% of patients (n= 11/13) had a healed IUI. Iatrogenic urinary tract injury is not uncommon in salvage procedures for pelvic sepsis, even in an experienced tertiary referral centre. Most injuries were diagnosed postoperatively which affects the severity of these complications, emphasising the need to improve intraoperative diagnostic modalities.

Iatrogenic Injuries of Urinary Tract : Outcomes of Surgical Repairs

Iatrogenic urinary tract injuries are known complications of digestive and pelvic surgeries. We retrospectively reviewed 13 patients with bladder injuries and 16 patients with ureteral injuries requiring surgical repair or stent placement in our hospital between 2013 and 2016. Obstetric-gynecologic surgery accounted for 10 bladder injuries and 11 ureteral injuries on hysterectomy and Cesarean section. Digestive surgery led to 1 bladder injury and 5 ureteral injuries on colon resection, and urologic surgery resulted in 1 injury on biopsy of a retroperitoneal tumor. Regarding bladder injuries, 10 patients underwent cystorrhaphy, and 3 patients received indwelling of a transurethral Foley catheter alone. Concerning ureteral injuries, 7 patients underwent repair of the injured ureter (ureteroneocystostomy in 5, and ureteroureterostomy in 2), and 9 patients received ureteral stent placement after postoperative retrograde urography. Repair failure was defined when urine leakage, urinary fistula, or urinary stricture requiring ureteral stent placement still existed at 90 days after the repair treatment. The bladder injuries in all 13 cases were successfully repaired. The ureteral injury treatments in 7 out of 16 patients (43.8%) were judged as being unsuccessful because of the condition requiring a ureteral stent at 90 days. There was a correlation between the delayed diagnosis of ureteral injury and unsuccessful repair. The present study showed that the prompt identification of urinary tract injuries, especially ureteral injuries, can result in decreased morbidity andsubsequently improved outcomes.

Early and Late Diagnosis of Iatrogenic Urinary Tract Injuries During Obstetric and Gynecological Operations

Objectives: We aimed to present urinary tract injuries occurring during obstetric and gynecological operations and their clinical consequences. Methods: Twenty-three patients had urological organ injury during obstetric and gynecological operations in a tertiary care center between January 2010 and June 2016, were analyzed retrospectively. Etiologies, type of injury, diagnostic process, treatment methods and complications of urologic injuries and success rate have been investigated. Injuries were categorized into two groups as intra-operative early injuries and post-op late injuries. Early injuries were laceration, rupture, ligation and late injuries were hydronephrosis, contrast material leakage or fistula. Results: Eight patients were diagnosed during operation period or post-op early period and 15 patients who were referred from other hospitals. Thirteen of the injuries were gynecologic and 10 of them were obstetric. Mean age of operated patients was 34.2±9.4 (23-65) years. Ureteral injury and bladder injury was detected respectively in six and two patients getting early diagnosis. Fistula (5/15), hydronephrosis secondary to urethral stricture (3/15) and vaginal erosion (3/15) were detected as late diagnosed injuries. In a patient whom ureter was ligated non-functioning kidney has developed. Conclusions: To reduce rate of urinary system injuries a sound knowledge of anatomy is required and corrected surgical techniques should be used. Early diagnosis and therapy may prevent complications and loss of organs that may lead to morbidity.

Iatrogenic urinary tract injuries: etiology, diagnosis, and management.

Iatrogenic injury to the urinary tract, including the kidneys, ureters, bladder, and urethra, is a potential complication of surgical procedures performed in or around the retroperitoneal abdominal space or pelvis. While both diagnostic and interventional radiologists often play a central and decisive role in the identification and initial management of a variety of iatrogenic injuries, discussions of these injuries are often directed toward specialists such as urologists, obstetricians, gynecologists, and general surgeons whose procedures are most often implicated in iatrogenic urinary tract injuries. Interventional radiologic procedures can also be a source of an iatrogenic urinary tract injury. This review describes the clinical presentation, risk factors, imaging findings, and management of iatrogenic renal vascular and urinary tract injuries, as well as the radiologist's role in the diagnosis, treatment, and cause of these injuries.

Multidetector Computed Tomography of Iatrogenic Urinary Trauma - Pictorial Review

Abdomino-pelvic interventional and surgical procedures can result in iatrogenic urinary tract injury. Radiological diagnosis can be difficult to establish because findings are caused by iatrogenic trauma, and by underlying disease and therapeutical procedures. We performed multidetector computed tomography (MDCT) in patients with suspected urinary tract trauma with scanning protocol selected according to the suspected type of injury: non-enhanced scanning for detection of fluid collections, MDCT angiography for renal parenchymal and vascular changes, MDCT urography for pelvicalyceal and ureteric injuries, and MDCT cystography for bladder and urethral lesions. The injuries were found after urologic, general surgical and gynaecological/obstetric procedures. Renal parenchymal injuries were caused by blunt (extracorporeal shock-wave lithotripsy) or penetrating trauma (renal biopsy), with formation of subcapsular, perinephric and/or paranephric haematomas. Renal vascular pedicle changes after kidney transplantation were precisely defined using MDCT angiography. MDCT urography depicted leakage of contrast material from the pelvicalyceal system after nephron-sparing surgery, from the ureter after kidney transplantation, and from bladder tear after caesarean section, while urethral injury after bladder catheterization was diagnosed using MDCT cystography. MDCT angiography and/or MDCT urography present methods for evaluation of iatrogenic urinary tract trauma because they enable fast and accurate diagnosis and planning of surgical and interventional procedures. Keywords: Iatrogenic disease, urinary tract, multislice computed tomography

VID-05.10: Management of iatrogenic urinary tract injuries

VID-05.10: Management of iatrogenic urinary tract injuries

Fibrin Sealant for the Management of Genitourinary Injuries, Fistulas and Surgical Complications

We report our preliminary experience with the use of fibrin sealant to manage iatrogenic urinary tract injuries, complex urinary fistulas, and urological surgical complications. Topical fibrin sealant was used in 19 patients for iatrogenic urinary tract injury during gynecological or general surgical procedures (7), complex urinary fistulas (5) or urological surgical complications (7). Successful resolution of the injury, fistula or complication was attained after a single application of fibrin sealant in the 18 patients (94.7%) in whom a direct injection technique was used. The only failure (formation of a vesicovaginal fistula) occurred with the air driven sprayed sealant delivery technique after sutured closure of iatrogenic cystotomy during vaginal hysterectomy. Liquid fibrin sealant appears to be safe and prudent for use in urological "damage control" from trauma, fistulas or surgical complications. Direct injection over a sutured urinary anastomosis appears to be highly effective in preventing urinary drainage. Additional study is needed to define further the role and best use of tissue adhesives in urology.

Iatrogenic injuries to ureter, bladder and urethra during abdominal and pelvic operations.

Abdominal and pelvic operations at Departments of Obstetrics and Gynaecology, and General Surgery play an important role in ureteral, bladder and rarely urethral injuries. Fifty-nine patients with iatrogenic ureteral, bladder and urethral injuries were treated at the Department of Urology, Atatürk University Research Hospital, between 1985 and 1995. These injuries were urinary vaginal fistulas in 43 patients (vesicovaginal 33, ureterovaginal 7, urethrovaginal 2 and vesicovaginal plus urethrovaginal 1), ureteric ligation in 9, bladder laceration in 7. These injuries were treated by different methods. All patients were followed up by intravenous urography (IVU) and urine culture three months later. It must be borne in mind that iatrogenic urinary tract injuries are not rare. Bladder and ureteral catheterization must be performed to prevent these complications.