Iatrogenic bladder and ureteral injuries following gynecological and obstetric surgery. 2023

Ann-Sophie Jensen, and Martin Rudnicki
Department of Obstetrics and Gynecology, University of Southern Denmark, Odense University Hospital, Region of Southern Denmark, Odense, Denmark.

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 11.4 days (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 38.0 days (95% CI 22.0-54.0) and transurethral catheterization for 16.9 days (95% CI 5.3-28.4), or by ureteral stenting for 46.7 days (95% CI 31.5-61.2) and transurethral catheterization for 6.25 days (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.

UI MeSH Term Description Entries
D007049 Iatrogenic Disease Any adverse condition in a patient occurring as the result of treatment by a physician, surgeon, or other health professional, especially infections acquired by a patient during the course of treatment. Hospital-Acquired Condition,Condition, Hospital-Acquired,Conditions, Hospital-Acquired,Disease, Iatrogenic,Diseases, Iatrogenic,Hospital Acquired Condition,Hospital-Acquired Conditions,Iatrogenic Diseases
D008297 Male Males
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D011788 Quality of Life A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral, social environment as well as health and disease. HRQOL,Health-Related Quality Of Life,Life Quality,Health Related Quality Of Life
D001743 Urinary Bladder A musculomembranous sac along the URINARY TRACT. URINE flows from the KIDNEYS into the bladder via the ureters (URETER), and is held there until URINATION. Bladder,Bladder Detrusor Muscle,Detrusor Urinae,Bladder Detrusor Muscles,Bladder, Urinary,Detrusor Muscle, Bladder,Detrusor Muscles, Bladder
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013513 Obstetric Surgical Procedures Surgery performed on the pregnant woman for conditions associated with pregnancy, labor, or the puerperium. It does not include surgery of the newborn infant. Obstetric Surgical Procedure,Obstetrical Surgery,Obstetrical Surgical Procedures,Procedure, Obstetric Surgical,Procedures, Obstetric Surgical,Surgery, Obstetric,Surgical Procedure, Obstetric,Surgical Procedures, Obstetric,Obstetric Surgeries,Obstetric Surgery,Obstetrical Surgeries,Obstetrical Surgical Procedure,Procedure, Obstetrical Surgical,Procedures, Obstetrical Surgical,Surgeries, Obstetric,Surgeries, Obstetrical,Surgery, Obstetrical,Surgical Procedure, Obstetrical,Surgical Procedures, Obstetrical
D014513 Ureter One of a pair of thick-walled tubes that transports urine from the KIDNEY PELVIS to the URINARY BLADDER. Ureters

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