Urological injuries during hysterectomies: A 6-year review


Dr Gowri Dorairajan, Type V/4, Dhanvantari Nagar, JIPMER, Pondicherry 605006, India. Email: gowridorai@sify.com


Aim:  Urological injuries that occur during hysterectomy are a rare but important cause of morbidity. An understanding of the risk factors can help us to reduce their incidence and studying their management and outcome could help us to evolve optimal management strategies. The aim of the present study was to examine the incidence of urological injuries that occur during hysterectomy and to determine the risk factors, management and outcome of such injuries.

Methods:  A retrospective analysis of cases of urological injuries sustained during hysterectomies carried out from June 1996 until May 2002, at our institution. The chi-squared test was applied for statistical analysis.

Results:  The overall incidence of urological injuries was 0.40% (0.28% bladder and 0.12% ureteral). No ureteral injuries occurred during vaginal surgery. The incidence of bladder injury was significantly higher in non-descent vaginal hysterectomies compared with abdominal hysterectomies or vaginal hysterectomies for genital prolapse (P < 0.05). Hysterectomy for ovarian malignancies had a significantly higher risk for bladder injuries compared with other indications. Bladder injuries detected during vaginal hysterectomies could be managed through the vaginal route. All the repairs healed successfully.

Conclusions:  Non-descent vaginal hysterectomy and hysterectomy for ovarian malignancies have a higher risk of bladder injury. Urological injuries during hysterectomy are uncommon. Early detection and appropriate management ensure successful healing and minimal long-term sequelae.