Urological injuries during obstetric and gynaecological procedures: a retrospective analysis over a period of eleven years

Background: To determine frequency and nature of urological injuries in obstetric and gynaecological procedures and their consequences and mode of management in a tertiary care hospital SDM Medical college and hospital, Dharwad, India.Methods: A retrospective study of all obstetric and gynaecological surgeries over a period of 11 years from January 2004 to December 2014 was carried out at Department of Obstetrics and Gynaecology, SDM Medical College and Hospital, Dharwad, India. Cases with the documented urological injuries were analyzed further. A total of 18,250 patients underwent obstetric and gynaecological procedures like lower segment caesarean section, various types of hysterectomies were analyzed. Cases with urologic injuries were identified and analyzed for risk factor, timing of diagnosis, their management and consequences.Results: Out of 18,250 patients undergoing various surgeries, 37(0.2%) patients had bladder injury and 4(0.02%) patients had ureteric injury. In gynecologic procedures, the incidence of bladder injury was highest in radical hysterectomy (2 out of 79, 2.5%) followed by TLH/LAVH (4 out of 299, 1.3%), NDVH (7 out of 490, 1.4%) TAH (5 out of 1360, 0.37%), laparotomy (1 out of 347, 0.29%) and vaginal hysterectomy (3 out of 1529, 0.2%). Three ureteric injuries were noted in cases of TLH/LAVH (3 out of 299) and one in case of TAH (1 out of 1360, 0.07%).Conclusions: Even though urological injuries are statistically rare, they are responsible for significant morbidity. Bladder injuries are more common, but are easy to manage with earlier diagnosis. Ureteric injuries which are usually diagnosed late and hence cause more morbidity than bladder injuries