Clinical analysis of urinary tract injury in gynecologic surgeries: Nine cases report

Objective To investigate the high risk factors, clinical characteristics and prevention methods of urinary tract injury during gynecologic surgeries. Methods Between January 2001 and December 2010, a total of 9 cases of urinary tract injuries occurred during gynecological surgeries in our institution. The high risk factors, conditions of injuries, clinical characteristics, thera-peutic methods and prognosis were retrospectively analyzed. Results Nine cases of urinary tract injuries (0.10%) occurred among the total 8672 cases of gynecologic surgery performed in recent 10 years, including 6 cases of ureteral injuries (0.07%), 3 cases of blad-der injuries (0.03%). The main diseases of these 9 cases were as follows: adenomyosis and endometriosis in 4 cases (44.4%), uterine fibroids in 2 cases (22.2%), cervical leiomyoma in 1 case (11.1%), advanced ovarian cancer in 1 case (11.1%), cervical cancer in one case (11.1%). There were 7 cases (77.8%) with pelvic adhesions, 7 cases (77.8%) with enlarged uterus (6 to 13 weeks), 4 cases (44.4%) with abdominal surgery history, 2 cases (22.2%) happened when the laparoscopic and hysteroscopic operatively were newly performed in our department. Six cases were found during the operations (66.7%), the other 3 cases (33.3%) were observed when the abnormal symptoms appeared in 3 to 14 days postoperations, including abdominal distention, back pain, fever, decreased urine volume, and vagina seepage. Conclusions The high risk factors of urinary tract injury in gynecologic surgeries are severe abdominal adhesions, uterus enlargement and abdominal surgery history. Ureteral injury is easy to be ignored. These high risk factors should be paid enough attentions to prevent the urinary tract injuries.