Urological injuries following gynecologic surgery: clinical manifestations, diagnosis and management

Abstract

Iatrogenic urinary tract injury constitutes a rare but serious complication of gynecologic surgery, occurring in 0.3% to 1.5% of all procedures. Delayed diagnosis and repair are associated with increased postoperative morbidity, mortality and a long-term negative impact on the quality of life. Intraoperative detection of urinary tract injuries allows for prompt repair, facilitates management and speeds up recovery. Bladder injuries are 3 times more common than ureteral injuries, and usually are recognized and repaired immediately with minimal complications. Undetected ureteral injuries lead to severe postoperative complications such as the formation of genitourinary fistulas, sepsis, renal loss and death. In this review we aim to describe the postoperative clinical manifestations, the diagnostic methods and therapeutic strategies for the management of urinary tract injuries, whether in the acute or delayed setting, in an effort to reduce the potential impact of subsequent complications to both patient and surgeon. Timely and effective repair of urinary tract injuries is critical to improve patient outcome, mitigate litigation risk, and allow an uneventful postoperative recovery in a careful manner.