Skip to main content Skip to main navigation menu Skip to site footer

Urological complications following obstetric-gynecologic procedures at Sanglah General Hospital, Bali-Indonesia



Abstract

Background: Surgical complications are often inevitable despite advances and improvement in surgical skills and science. Objective: We performed a study to investigate the clinical features of urological injury following obstetric and gynecologic procedures. Methods: We identified the urological complications which arose during or following obstetric-gynecologic procedures at Sanglah General Hospital, Bali from January 2014 to July 2017. The retrospective data retrieved included details of the procedures, the sites of injury, the treatments, and the outcomes. Results: We had 41 patients with urologic complications following obstetric and gynecologic procedures. According to the medical records, 14 had a bladder injury, 6 had a ureteral injury, 3 had both bladder and ureteral injuries, 16 had a vesicovaginal fistula, and 2 had a ureterovaginal fistula. A total abdominal hysterectomy was the most common procedure underlying complications. The second most common was radical abdominal hysterectomy. All cases of bladder injury underwent a primary suturing during surgery without complications. Where the ureter was injured, 2 patients underwent primary suturing, 5 underwent Boari flap technique, 2 underwent end-to-end anastomosis, and 2 underwent laparoscopic ureteroneocystostomy. Vesicovaginal fistula (VVF) was mostly managed using the transvaginal approach with a tissue flap. The overall success rate of VVF repair was 75% after a primary repair. Conclusion: Bladder injuries were the most common urological injury during obstetric and gynecologic procedures. VVF management with various surgery techniques yields a good result.

Keywords: obstetric-gynecologic procedure complication urological complication bladder injury VVF

References

  1. REFERENCES
  2. Gilmour D.T., Dwyer P.L., and Carey M.P., Lower urinary tract injury during gynaecologic surgery and its detection by intra-operative cystoscopy. Obstet. gynecol. 1999; 95: 883-889.
  3. Lang EK, Lanasa JA, Garrett J, Stripling J, Palomar J. The management of urinary fistulas and strictures with percutaneous ureteral stent catheters. The Journal of urology. 1979;122(6):736-40.
  4. Lee JS, Choe JH, Lee HS, Seo JT. Urologic Complications Following Obstetric and Gynecologic Surgery. Korean Journal of Urology. 2012;53(11):795-799. DOI:10.4111/kju.2012.53.11.795.
  5. Pal DK, Wats V, Ghosh B. Urologic complications following obstetrics and gynecological surgery: Our experience in a tertiary care hospital. Urology Annals. 2016;8(1):26-30. DOI:10.4103/0974-7796.158502.
  6. Frankman EA, Wang L, Bunker CH, Lowder JL. Lower Urinary Tract Injury in Women in the United States, 1979–2006. American journal of obstetrics and gynecology. 2010;202(5):495.e1-495.e5. DOI:10.1016/j.ajog.2010.01.013.
  7. Ozdemir E, Ozturk U, Celen S, Sucak A, Gunel M, Guney G, Imamoglu MA, Danisman AN. Urinary complications of gynecologic surgery: iatrogenic urinary tract system injuries in obstetrics and gynecology operations. Clin Exp Obstet Gynecol. 2011;38:217–220.
  8. Thompson JD. Operative injuries to the ureter: prevention, recognition, and management. In: Rock JA, Thompson JD, editors. TeLinde's operative gynecology. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 1997. pp. 1135–1174
  9. Djakovic N, Plas E, Martínez-PiñeiroL, MorY, Santucci R. A, et al. Guidelines on Urological Trauma European Association of Urology. 2012; 36-38.
  10. Underwood P, Operative injuries to ureter, Rock J, Jones H, TeLinde's Operative Gynecology. Tenth edition. Lippincott Williams. Philadelphia. 2008; 962-963.
  11. Kim J-H, Moore C, Jones JS, Rackley R, Daneshgari F, Goldman H, Vasavada S. Management of ureteral injuries associated with vaginal surgery for pelvic organ prolapse. Int Urogynecol J. 2006;17:531–5. DOI: 10.1007/s00192-005-0020-7
  12. Hammad, F.T., AlQaiwani, K.M. & Shirodkar, S.S. The role of urologists in the management of urological injuries during obstetric and gynaecologic surgery. Int Urogynecol J. 2010; 21: 1237. DOI: 10.1007/s00192-010-1173-6
  13. Durrani SN, Rehman A, Khan S, Ullah H, Khan MK, Ullah A. Ureteral trauma during open surgery: etiology, presentation and management. J Ayub Med Coll Abbottabad. 2013;25:86–9
  14. Hadley, H.R. Vesicovaginal fistula. Curr Urol Rep. 2002; 3: 401. DOI: 10.1007/s11934-002-0085-5
  15. Kumar S, Kekre NS, Gopalakrishnan G. Vesicovaginal fistula: An update. Indian J Urol. 2007;23:187–91.
  16. Wilson A, Pillay S, Greenwell T. How and why to take a Martius labial interposition flap in female urology. Translational Andrology and Urology. 2017;6(Suppl 2):S81-S87. DOI: 10.21037/tau.2017.04.38.
  17. Chibber, P. J., Shah, H. N. and Jain, P. Laparoscopic O’Conor's repair for vesico-vaginal and vesico-uterine fistulae. BJU International. 2005;96:183–186. DOI: 10.1111/j.1464-410X.2005.05592.x

How to Cite

Santosa, K. B., Tirtayasa, P. M. W., & Oka, A. A. G. (2018). Urological complications following obstetric-gynecologic procedures at Sanglah General Hospital, Bali-Indonesia. Bali Medical Journal, 7(2). https://doi.org/10.15562/bmj.v7i2.949
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
10

Total
3

Share

Search Panel

Kadek Budi Santosa
Google Scholar
Pubmed
BMJ Journal

Pande Made Wisnu Tirtayasa
Google Scholar
Pubmed
BMJ Journal

Anak Agung Gede Oka
Google Scholar
Pubmed
BMJ Journal