Urologic Complications after Gynaecologic and Obstetric Surgery at the Urology-Andrology Teaching Clinic of Teaching Hospital of Cotonou

Abstract

Objective: To study the epidemiology and current trend in the management of urologic complications following obstetric and gynaecologic surgeries at CUUA University hospital of Cotonou. Patients and Methods: It was a retrospective study of patients referred with urologic complications following obstetric and gynaecological surgeries. The study took place at the Teaching Clinic of Urology Andrology at CNHU of Cotonou between April 1, 2008 and March 31, 2013. Results: Fortyone patients were studied. They represented 3.5% of people hospitalized at CUUA throughout the study period. The average age was 41 years swith range of 20 and 57 years. Twenty-one (51.2%) of them were married. Thirty patients (73.2%) were referred from a non-academichospital, while 7 patients (17.1%) were referred from academic hospital. Caesarean section was the primary gyneco-logical surgery in 22 cases (53.7%) and hysterectomy in 19 cases (46.3%). Clinically, the pre-dominant symptoms were leakage of urine throughout the vagina and obstructive anuria with or without back pain. We found 31 cases of VVF, 5 cases of bilateral ligation of the ureters, 3 cases of unilateral ligation of the ureter, 1 ureteralinjury and 1 uretero-vaginal fistula. These complications were diagnosed postoperatively in 95.1% of cases. Surgeries done included VVF repair in 31 cases (75.6%), unilateral ureteral reimplantation in 4 cases (9.8%), removal of ligation of the ureters in 3 cases (7.3%), bilateral ureteral reimplantation for 2 cases (4.9%) and end-to-end anastomosisin 1 case (2.4%). The postoperative period was uneventful in 29 cases and we observed 7 cases of surgical site infection. The overall success rate was 87.8%. Conclusion: Urological complications following gynecologic surgeries managed at the urologic department of teaching hospital of Coto-nou had an even higher incidence. Early diagnosis especially during the * Corresponding author. H. P. Pascal et al. 122operative procedure would save the patients' serious complications and open surgery due to the lack of endo-urological facilities. The most important factor in prevention is good knowledge of pelvicanatomy and good knowledge of the surgical techniques of caesarean operation section and trans-abdominal hysterectomy.

Management and Outcome of Postoperative Complications among the Patients Undergoing Common Obstetric and Gynaecological Surgery outside the RMCH

“…This study showed that 85.9% patients were referred from clinics while 14.1% patients were referred from district hospitals, similar to 73.2% and 17.1% respectively reported by Pascalet al 8 The incidence of re-lapartomy in our study was 3.7% which was more than 0.80% reported by Alam et al 9 Indication of repeat surgery in this study was internal hemorrhage 11.88%, uncontrolled PPH 6.67%, rectus sheath hematoma 11.11%. The result is near to that of Akhteret al 10 who found it 48.99%.…”

“…In this hospital setting 574 (85.03%) patients were improved by conservative treatment,405 (60%) patients required at least one unit of blood transfusion. 41 (45.55%) cases genitourinary fistula were repaired overall success rate was (90.9%).It was similar to a study by Pascal HP et al 12…”

Frequency of Urological Injuries in Obstetrical and Gynaecological Surgery at Tertiary Care Hospital

“…Health workers who perform surgeries lack understanding of the anatomical link between the urinary and genital tracts. 26 Preventing blind blood vessel clamping, working closely to pathology, identifying the ureteral course prior to dissection, careful movement from the operation site, and brief diathermy treatments can all help to reduce ureteral injuries. 27 Surgically, the ureteric injuries are challenging to diagnose.…”

“…Compared to ureteral injuries, bladder injuries have been found to occur 2-3 times more frequently. 15 Post surgery, urogenital fistula formation and leakage in bladder are painful for patient and cause the surgeon concern and a sense of failure. Similar to the development of anuria right after surgery, this condition necessitates rapid care for patient.…”

Urological injuries following obstetrical and gynecological surgeries

“…Gynaecological surgeries have been reported to be responsible for 75% of the injuries to the ureter. At the same time, it has been noted that bladder injuries are 2 to 3 times more frequent than ureteral injuries 2 .…”