Bladder and ureteric injury in gynaecological surgery with surgical interventions

Abstract

INTRODUCTION: Urological injury in obstetrics and gynaecology are not uncommon because there is a close anatomical association between reproductive and urological system. The close embryonic development and anatomical proximity of the urinary bladder and genital organs, are responsible for the urinary tract to injury during surgical procedures in the female pelvis.

Aims and objectives The study was a retrospective analysis of all obstetric and gynaecological surgeries over a period of two years from December 2018 to December 2020, there were 2990 LSCS and 10 postpartum hysterectomies done in the department of Obstetrics and gynaecology, department of MYH, MGM Medical college Indore in the given study period. This study was done in the department of Gynaecology in collaboration with department of surgery. Cases with the documented urological injuries during these procedures were analysed further

MATERIAL AND METHODS: The study was a retrospective analysis of all obstetric and gynaecological surgeries over a period of two years from December 2018 to December 2020, there were 2990 LSCS and 10 postpartum hysterectomies done in the department of Obstetrics and gynaecology, department of MYH, MGM Medical college Indore in the given study period. This study was done in the department of Gynaecology in collaboration with department of surgery. In suspected cases of bladder injuries cystogram X-ray of the bladder after injection of contrast medium is performed.

RESULTS: In this study mean age of bladder injury is 34.8 years and for ureteric injury 35 years. Parity for bladder injury 2.4 and for ureteric injury 3. Gestational age is similar for both is 37 weeks. Among all patients who underwent caesarean section 1.5% suffered from bladder injury, 0.01% ureteric injury and 0.01% for ureteric and bladder injury. Similarly, in peripartum hysterectomy, 40% suffered from bladder injury and no one have ureteric injury. Total 52 [1.5%] cases have injury. Among all patients who suffered from bladder injury, mostly cases are primigravida cases, which are 57% cases. 13% cases are more than two section patients. Others are previous two section 9%, Placenta previa and placenta accreta 7.6%, Previous history of myomectomy and hysterotomy 3.8% and 1.9% cases from 2nd stage labour and CPD patients. In bladder injury, most of the cases are bladder dome [81.5%], posterior wall [14%], lateral wall [4%] cases and none cases in bladder neck injury.  Most bladder injury repaired by triple layers vicryl with SPC insertion [44%], without SPC [38%] and only catheterization only 11% cases. All ureteric injury repaired by DJ stent insertion with repair. SPC removed after 14 days.

CONCLUSION: 1.5% of the bladder injuries were observed. Early detection and prompt management of bladder injury can decrease the morbidity and mortality in LSCS cases. The incidence urological injuries during obstetrics and gynaecological procedures are rare but the morbidity associated these are significant. Therefor surgeons should be more cautious and high degree of suspicion can help in early diagnosis and avoid the sequel.