IATROGENIC UROLOGICAL INJURIES IN PELVIC SURGERIES, OUR INSTITUTIONAL EXPERIENCE- A DESCRIPTIVE STUDY

BACKGROUND Ureteric and bladder injury is a serious concern during pelvic surgery and represents one of the most dreaded complications during gynaecologic operations with an overall incidence ranging from 0.5% to almost 30%. The rate of ureteral injury is increased when technically demanding laparoscopic and radical pelvic surgeries. Aims and Objectives-To study the incidence of ureter and bladder injuries detected intraoperatively/postoperatively following pelvic surgeries in the gynaecology and oncology departments of our institution. This study describes our experience in the management of ureteric/bladder injuries following pelvic operations and outcome of management of this condition in our local setting. MATERIALS AND METHODS This is a retrospective descriptive study of patients with iatrogenic injuries to the ureter and bladder following pelvic surgeries that were managed in our department from June 2016 to January 2018. Analysis of the patient's diagnosis, indication for surgery, type of surgery, time at diagnosis of injury, presenting features and the type of management was done. RESULTS A total of 9 ureteric injuries and 6 bladder injuries were identified out of 293 pelvic surgeries performed in the study period. All bladder injuries were diagnosed and managed intraoperatively. 80% of ureteric injuries were diagnosed postoperatively with fever, flank pain and leakage of urine being the most common presentation. Duration of symptoms ranged from immediate post-op period to up to 6 months after surgery. 45% were diagnosed with ureteric stricture, 33% with ureterovaginal fistula and 22% were diagnosed intraoperatively. Incidence of ureteric injuries in simple hysterectomy for benign causes was 1.8% and for Wertheim's hysterectomy for malignancy was 6%. Incidence of ureteric injuries following laparoscopic hysterectomy was 7%. Ureteric injury following APR was found to be 7%. We performed ureteroneocystostomy for 4 cases, Boari flap for 2 cases, transureteroureterostomy in 1 case, nephrectomy in 1 case and ureterocolonic anastomosis in 1 patient. Postoperative complications observed were surgical site infection in 33% and urosepsis in 11% of patients. Mortality was nil. CONCLUSION Laparoscopic and Wertheim's hysterectomy were most commonly associated with ureteric injuries. Meticulous surgical technique as well as identification of the course of the ureter and associated anatomic locations where injury is most likely to occur is important to decrease the risk of ureteric injury. Timely recognition of ureteric injury and its management is associated with good outcome.