Iatrogenic urinary tract injuries during obstetric and gynecological operations in Assiut University Women Health Hospital

Abstract

Background and aim The close proximity of the urinary tract to the female genital system makes it vulnerable to damage during pelvic surgical procedures. The objective of the current study was to evaluate iatrogenic urinary tract injuries (UTIs) caused by obstetrical and gynecological procedures. Patients and methods The current study was conducted at Department of Obstetrics and Gynecology, Assiut University Hospitals, in the period between March 2018 and March 2021. All women with UTIs secondary to obstetrical or gynecological surgeries during the study period were recruited in the study. Results A total of 20 636 women were scheduled for different obstetric or gynecological surgeries, and 170 (0.82%) of them experienced iatrogenic UTIs, 161 (94.7%) women had injury during obstetric surgeries, whereas the other nine (5.3%) had gynecological surgeries. Operations were repeated cesarean section (34.2%) and placenta previa (54.1%) in obstetric surgeries and repeated section in gynecological surgeries (33.3%). Iatrogenic UTIs were detected intraoperatively in 167 (98.2%) women, whereas in only three patients, detection was delayed. Overall, eight (4.7%) patients had both bladder and ureteric injuries, whereas bladder injury alone occurred in 154 (90.6%) patients and another eight (4.7%) patients had ureteric injuries alone. ICU admission was needed in 43 (25.3%) patients. Conclusion Although frequencies of UTIs in obstetric and gynecological surgeries were found to be relatively low, yet it may lead serious morbidity and outcome. Proper antenatal care and good knowledge of pelvic anatomy may help in decreasing its frequency.