Urinary tract injuries during pelvic surgery: Incidence rates and predisposing factors

Objective: To review the cases of urinary tract injury following major pelvic surgery that were treated in our hospital over the last 12 years, in relation to possible predisposing factors and incidence rates of injury arising in various surgical procedures. Materials and methods: From 8,824 major gynecological operations performed in our department, 29 cases of intraoperative urinary tract injury were found. Thirty eight patients visited the urology department during the same period for the management of urogenital fistula following pelvic surgery. Parameters that were examined included type of urinary tract injury, indication for surgery, type of operation, coexisting pathological conditions, past history of pelvic surgery or pelvic irradiation, and the delay in the recognition and management of the urinary tract injury. Results: The overall incidence of urinary tract injury in pelvic surgery was 0.33%. The incidence of urinary tract injury in radical hysterectomy was higher than that of total abdominal hysterectomy(0.76 vs 0.26%). Of the intraoperative urinary tract injuries, 48.4% coexisted pelvic pathologies. Of all the cases with urinary tract injury, the most common type of operation was total abdominal hysterectomy (n=45, 67.2%), and the most common indication was uterine myoma (n=25, 36.9%). The most common type of urinary tract injury was bladder injury, including bladder laceration and vesicovaginal fistula (n=57, 76.1%). The frequency of reoperation was found to be lower in patients with a shorter delay in the recognition of the injury (p<0.05). Conclusion: Possible predisposing factors for urinary tract injury are coexisting pelvic adhesion, distortion of normal pelvic configuration, previous irradiation history, previous operation history, and the extent of surgery. In high-risk patients, proper evaluation is needed to avoid urology complications before operation.