Injury to Urinary Organs during Natural Deliveries, Caesarean Sections and Peripartum Hysterectomies

Objective: The purpose of the study is to analyze the causes and types of injuries to the urinary organs related to past deliveries. Material and methods: There were 34,866 deliveries at the Obstetric-Gynecological Ward, Regional Specialist Hospital in Radom between 1998 and 2016. Medical records of 11 patients with injuries to the urinary organs related to past delivery were retrospectively studied. Results: The following injuries were found: - Ligation of the left ureter: 1 case, - Injury to the urinary bladder: 10 cases - Vesicovaginal fistula (VVF): 1 case (following injury to the urinary bladder at hysterectomy in the postpartum¬ period). In 9 patients, the detected injuries were managed during hospitalization for labor, in 3 cases the injuries were diagnosed during the postpartum period; one patient was treated in the General Surgery Ward on 5th day following natural delivery. Another patient suffered injury to the urinary bladder during hysterectomy in the postpartum period. It was sutured up. VVF was diagnosed on 10th day after the surgery, and was successfully managed at the Urology Department. The injuries to the urinary organs were most frequently related to hysterectomies in the peripartum and postpartum period (54.5%) Conclusions: 1. Both peripartum and postpartum hysterectomy pose a high risk of urological complications, 15.8% in the group of discussed patients. 2. Patients at high risk of complications necessitating peripartum hysterectomy should be duly transferred to reference wards to provide multi-specialist medical care.