Urologic injuries during gynecologic surgery, a 10‐year review

Satitniramai, Sikarn; Manonai, Jittima

doi:10.1111/jog.13238

Cited by 23 publications

(21 citation statements)

References 17 publications

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“…The literature data regarding this issue is conflicting. In some studies, the highest incidence has been found with abdominal hysterectomies (17,18), but others reported a higher incidence with laparoscopic hysterectomies (19,20). In contrast, in a prospective study by Ibeanu et al (7), the authors reported that the vaginal hysterectomy was associated with more ureteric injuries (2.6%) than abdominal (1.7%) and laparoscopically assisted vaginal hysterectomies (0%), in accordance with our experience.…”

Section: Discussionsupporting

confidence: 87%

Urinary Tract Injury at Gynecological Surgery: Results from a Tertiary-Care Institution

Toptaş

Uysal

Karataş

et al. 2017

Gynecol Obstet Reprod Med

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OBJECTIVE:To identify clinical features of urinary tract injuries detected during or after gynecologic surgeries, with a specific focus on incidence and role of surgeon and surgical route on urinary injury. STUDY DESIGN:The institutional database from January 2009 to January 2017 was reviewed with respect to gynecologic (non-obstetric) surgeries and urinary injuries. RESULTS:A total of 8719 gynecologic surgeries were identified. Of these, 46 (0.52%) were found to be complicated with a bladder (n=34, 0.38%), ureteral (n=11, 0.12%) and/or urethral injury (n=1, 0.01%). Bladder injuries occurred mostly at the superior part of the bladder, while ureteric injuries at the most distal part of the ureter. Ureteric injuries were mostly delayed (81.8% vs. 5.9%, p<0.001) and were more related to thermal injury than bladder injuries (45.5% vs. 8.8%, p=0.029). Among all surgical procedures, radical hysterectomy had the highest incidence for the ureteric injury (8.53%), while Burch colposuspension via minimally invasive route had the highest incidence for the bladder injury (16.6%). Cumulative incidence of urinary injury significantly differed according to the surgical route preferred (p=0.032), with the vaginal surgeries were associated with the highest incidence (0.96%). However, there was no such a difference in injury rates between the low-volume (0.55%) and high-volume (0.52%) surgeons (p=0.328) CONCLUSION: Overall incidence of lower urinary tract injury at gynecologic surgeries is low, does not differ according to annual number of surgeries performed, but increases with the vaginal surgeries.

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Section: Discussionsupporting

confidence: 87%

Urinary Tract Injury at Gynecological Surgery: Results from a Tertiary-Care Institution

Toptaş

Uysal

Karataş

et al. 2017

Gynecol Obstet Reprod Med

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“…The risk of bladder injury can be minimized at the outset of the procedure by retrograde filling, which allows the superior edge of the bladder to be identified (Wang et al, ). Injuries to the urinary bladder are the most common urinary tract complications in gynecological surgery and the risk could be lowered through a careful preoperative medical history, since the injury risk is associated with previous pelvic surgery and related adhesions (Satitniramai and Manonai, ). Care should be taken with the paravesical tissue during the anterior approach as it contains the vesical venous plexus, which consists of 2–5 main vein rows directly lateral to the bladder with various anastomoses.…”

Section: Discussionmentioning

confidence: 99%

“…Using the posterior approach, it is crucial to visualize the ureter before the peritoneum is incised as a laceration at deeper levels can cause fistulas and infections (Araco et al, ; Satitniramai and Manonai, ). Although it has not yet been shown to be a risk factor, it has been stated that the use of a laparoscopic approach in general rather than a different technique could contribute to ureteric injuries (Satitniramai and Manonai, ). Recently, it was stated that the ureter lies 1.3–2.0 cm lateral to the uterosacral ligament between the sacrum and the level of the ischial spine (Siff et al, ).…”

Section: Discussionmentioning

confidence: 99%

Anatomical structures at risk using different approaches for sacrospinous ligament fixation

et al. 2019

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For 50 years now, sacrospinous ligament fixation (SSLF) has been used to treat pelvic organ prolapse consequent on altered integrity of the pelvic myofascial structures. It is usually performed vaginally, but it has recently been performed laparoscopically through either an anterior or a posterior approach, with the broad ligament as a landmark to differentiate the two. In the present study, these two laparoscopic approaches were assessed using Thiel-embalmed cadavers. The anterior and posterior approaches were compared in terms of the closest distance to anatomical structures at risk, including pelvic viscera, the obturator nerve, and vascular structures. The posterior approach was more often closer to the investigated vessels and the rectum. The obturator nerve and the ureter were close to both the anterior and posterior approaches. The urinary bladder was closer using the anterior approach. From an anatomical standpoint, therefore, the anterior laparoscopic approach for SSLF is more likely to cause injury to the urinary bladder, whereas the posterior approach is more prone to causing rectal and vessel injuries. This study illustrates, from a basic science perspective, the importance of combining fascia research, novel endoscopic or minimally invasive surgical exposures informed by anatomy, and contemporary trends in gynecology in order to improve patient outcomes. Clin. Anat. 33:522-529, 2020.

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“…Urinary tract injuries are a known complication of gynecologic surgery, occurring in 0.18% -0.80% of procedures [1] [2] [3]. Specifically, the most common injuries are to the bladder, accounting for 52% -75% of all urologic injuries [1] [2].…”

Section: Introductionmentioning

confidence: 99%

Improving the Evaluation and Management of Cystotomy in Gynecologic Surgery with a Cadaver Surgical Curriculum

Presti¹,

Xu²,

Liu³

et al. 2021

OJOG

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Objectives: Urinary tract injuries are a known complication of gynecologic surgery, occurring in 0.18% -0.80% of procedures and most commonly involving the bladder. Appropriate identification, evaluation, treatment, and follow-up by gynecologic surgeons are important to reduce the associated long-term morbidities. The purpose of this study was to implement a comprehensive cadaver curriculum in cystotomy repair for OBGYN residents. Methods: This was a prospective observational cohort study including 10 OBGYN residents (PGY1-3) at a single institution in 2020 (56% of the 18 eligible residents). The curriculum consisted of a one-hour didactic lecture and one-hour hands-on surgical skills training with fresh frozen cadavers. Residents were evaluated in three domains: 1) knowledge, 2) surgical skills, and 3) confidence. Knowledge, confidence, and resident satisfaction were evaluated with pre-and post-surveys. The bladder model, derived from the ACOG Simulation Working Group, was used to evaluate surgical skills at baseline and at completion of the curriculum. Results: Across all three PGY levels, statistically significant improvements were observed in knowledge, surgical skills, and confidence after didactic and cadaver education (p = 0.001, p < 0.02, and p = 0.009 respectively). The largest increases in confidence occurred in residents' ability to describe and perform cystotomy repairs. Conclusions: Educating and training OBGYN residents to manage and repair cystotomies can be challenging given the low incidence of injury in the operating room. The cadaver surgical skills curriculum was an effective training module and remains an important component of skills training in conjunction with simulation and traditional didactic sessions.

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Urologic injuries during gynecologic surgery, a 10‐year review

Abstract: Urinary bladder injury was the most common urinary tract injury during gynecologic surgery. Previous pelvic surgery and the presence of adhesion were significant risk factors.

Cited by 23 publications

References 17 publications

Urinary Tract Injury at Gynecological Surgery: Results from a Tertiary-Care Institution

Urinary Tract Injury at Gynecological Surgery: Results from a Tertiary-Care Institution

Anatomical structures at risk using different approaches for sacrospinous ligament fixation

Improving the Evaluation and Management of Cystotomy in Gynecologic Surgery with a Cadaver Surgical Curriculum

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