Urinary tract injuries after hysterectomy

Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki, Uusimaa, Finland
Obstetrics and Gynecology (Impact Factor: 4.37). 08/1998; 92(1):113-8. DOI: 10.1097/00006250-199807000-00022
Source: PubMed

ABSTRACT To evaluate the nationwide incidence and characteristics of urinary tract injuries after laparoscopic hysterectomy, total abdominal hysterectomy, supracervical abdominal hysterectomy, and vaginal hysterectomy.
We analyzed retrospectively 142 urinary tract injuries after hysterectomy, reported to the National Patient Insurance Association in Finland from 1990 through 1995. The Finnish Hospital Discharge Register collects data on procedures from all hospitals, and 62,379 hysterectomies were carried out during the study period.
The total incidence of ureteral injury after all hysterectomies was 1.0 of 1000 procedures: 13.9 of 1000 after laparoscopic, 0.4 of 1000 after total abdominal, 0.3 of 1000 after supracervical abdominal, and 0.2 of 1000 after vaginal hysterectomy. Difficulties during an operation with a ureteral injury were encountered in 51%, 76%, 100%, and 100%; the failure rates of primary repair of a ureteral injury were 5%, 12%, 0%, and 0%; and the convalescence times after a ureteral injury were 86 days, 94 days, 71 days, and 47 days after laparoscopic, abdominal, supracervical abdominal, and vaginal hysterectomies, respectively. The incidence of bladder injury was 1.3 of 1000 procedures. Sixty-five percent of reported bladder injuries were fistulas, giving an incidence of vesicovaginal fistula of 0.8 of 1000 procedures after all hysterectomies: 2.2 of 1000 after laparoscopic, 1.0 of 1000 after total abdominal, 0 of 1000 after supracervical abdominal, and 0.2 of 1000 after vaginal hysterectomy. Difficulties during an operation with a bladder injury were encountered in 53%, 37%, 100%, and 0%; the failure rates of primary repair of a simple bladder injury were 5%, 18%, 0%, and 0%; the failure rates of primary repair of a vesicovaginal fistula were 17%, 20%, 0%, and 0%; and the convalescence times after a bladder injury were 51 days, 118 days, 71 days, and 99 days after laparoscopic, abdominal, supracervical abdominal, and vaginal hysterectomy, respectively.
The risk of ureteral injury is higher after laparoscopic hysterectomy compared with traditional hysterectomies.


Available from: Päivi Härkki, Aug 04, 2014
1 Follower
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCCIÓN La histerectomía es la segunda cirugía ginecológi-ca más frecuente en el mundo. Dentro de las ma-yores complicaciones de la histerectomía se en-RESUMEN Antecedentes: Las lesiones urológicas que ocurren durante las diferentes técnicas de histerectomía son una causa importante de morbilidad. Se ha descrito que son más frecuentes en las histerec-tomías realizadas por vía laparoscópica. Objetivo: Evaluar si la técnica influye sobre el número de lesiones urológicas, el tiempo operatorio y el sangrado durante la cirugía. Material y métodos: Se realizó un estudio observacional, retrospectivo y transversal de las pacientes sometidas a histerectomía tipo total abdominal (HTA), histerectomía total por laparoscopia (HTL), histerectomía subtotal (HST) e histerectomía vaginal (HV) del 1 de enero 2004 al 31 de diciembre de 2008 en el Centro Médico ABC. Se utilizó estadística descriptiva para el análisis del presente trabajo. Resul-tados: La incidencia global de las lesiones urológicas fue de 1.2%.(1.1% lesiones vesicales y 0.1% lesiones ureterales). La HTA fue la única técnica que presentó lesiones ureterales. La HTL fue la técnica que mostró mayor incidencia de lesiones vesicales. En cuanto al tiempo operatorio, la técnica más rápida fue la HV. La técnica que presentó la mayor cantidad de sangrado fue la HTL. Conclusiones: La histerectomía subtotal fue la técnica que pre-sentó menor incidencia de complicaciones y menor sangrado, por lo que en nuestro medio es la técnica recomendada. Palabras clave: Lesión ureteral, lesión vesical, lesión urológica, histerectomía.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Ureteral lesions during open hysterectomy, vaginal hysterectomy or laparoscopic hysterectomy have a rate of 0.2% up to 6%. Multiple complications may occur if the lesion is not recognised intra operatively: hydronephrosis, anuria (bilateral lesion), ureterovaginal fistula, ileus, peritonitis. The rate of recognition of an intra operative ureter lesion is 30% and it could rise up to 90% when cystoscopy with ureteroscopy is used at the end of the intervention. The article presents the case of a 46-year-old patient with uterine fibromatosis, whose pelvic ureter was sectioned during surgery. The lesion was recognised during surgery because, at the end of each intervention, the diuresis was stimulated by injecting Furosemide in order to detect the lesions of the ureters and urinary bladder.
    Journal of medicine and life 09/2014; 7(3):396-8.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background and Objectives: Our aim was to determine whether the use of routine cystoscopy increases lower urinary tract injury detection (bladder and/or ureter) after robotic surgery performed by gynecologic oncologists. Methods: A retrospective chart review of patients who presented for robotic hysterectomy from 2009-2012 was performed at 2 separate academic medical centers, one that performed routine cystoscopy and one that did not. Statistical analysis was performed with t tests and chi(2) tests. Results: We identified 140 cases without cystoscopy and 109 cases with routine cystoscopy. There were no intraoperative or postoperative urinary injuries detected in either group. There were no significant differences in age and body mass index. In the non-cystoscopy group, a larger specimen size (P < .001), less blood loss (P = .013), and a longer mean operative time were observed (P < .0001). In the routine cystoscopy group, more lymphadenectomies were performed with hysterectomy (P = .007) and more patients underwent hysterectomy for ovarian cancer (P = .0192). There were no differences in surgical indications or secondary procedures including bilateral salpingo-oophorectomy, radical hysterectomy, ureterolysis, and pelvic organ prolapse-related procedures. The minimum follow-up period was 30 days in both groups. Conclusion: Routine use of cystoscopy did not appear to affect the detection rate of intraoperative lower urinary tract injury during robotic gynecologic surgery because this rate was zero in both groups. However, cystoscopy is relatively simple to perform and can be efficiently incorporated into robotic surgery to avoid the severe morbidity and possible litigation surrounding a urinary tract injury.
    JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 07/2014; 18(3). DOI:10.4293/JSLS.2014.00261 · 0.79 Impact Factor