[Clinical analyses of 42 cases of urinary tract injury in gynecologic surgery].

OBJECTIVE To determine the clinical characteristics and management of urinary tract injuries incidental to gynecologic surgery. METHODS During the study period from Jan. 1, 1990 to Dec. 31, 2001, forty-two patients with urinary tract injuries in gynecologic surgery were analyzed retrospectively focusing on type and time of injury, diagnostic methods and managements of urinary fistula. RESULTS Forty-two urological injuries were incurred during the performance of 12 849 gynecologic surgical procedures, an incidence of 0.33% including of 11 ureteral injuries and 31 bladder injuries, an incidence of 0.09% and 0.24% respectively. Of the 11 ureteral injuries 5 occurred in the lower ureter, 4 occurred at the level of vecical entrance and 2 were in the region of the infundibulopelvic ligaments. Of the bladder injuries, all 31 occurred at the bottom or back of the bladder. Urinary tract injury was made intraoperatively in 32 patients (76%) and made postoperatively in 10 patients (24%). Urinary fistulae occurred in 14 patients (33%). Ten patients with urinary fistulae were diagnosed by comparing the concentration of electrolyte, urea nitrogen and creatine in drainage fluid with those in urine and blood. Infusion of methylene blue and/or cystoscopy were checked in 9 patients and 4 bladder fistulae were found positive results. All 8 ureteral fistulae were diagnosed by intravenous pyelography. An appropriate repair during operation, putting the double J-catheter and/or catheterization was useful. Forty-one patients were healed. CONCLUSION Most of urinary tract injuries in gynecologic surgery had optimal results when they were diagnosed early and managed correctly.