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Abstract
To determine the prevalence and types of iatrogenic urinary tract injuries during obstetrics and gynaecological procedures and to find out the possible risk factors.
Methods: In this cross sectional study all patients undergoing major obstetrics and gynaecological surgeries were included. Variables included the personal data, age of the patient at time of surgery, Indication , type of surgery , location and type of injury and possible risk factors. Surgical approach and cause of injury was determined. Data regarding risk factors was collected on specified proforma. Iatrogenic urinary tract injury was defined as any inadvertent injury to the urinary tract for which additional intervention and observation was required. Major surgery was any surgery with duration more than 30 minutes including opening of peritoneal cavity.
Results: Records of 1800 patients was studied. Out of 1900 patients 8(0.44 %) suffered from iatrogenic urinary tract injuries. Median age of patients was 33 years. The procedure in which most urinary tract injuries occurred was peripartum hysterectomy, second most common procedure was total abdominal hysterectomy. Most common injury was injury to urinary bladder. It was injured in 5 (0.27 %) cases.Ureters were damaged in 2 (0.11%) patients. Urethra was damaged during.1( 0.05%) procedure. The main risk factor was previous surgery with resultant adhesions present in 75% of patients having iatrogenic urinary tract injuries. Seven cases of injury were diagnosed at the time of operation and successfully repaired. 0ne case was diagnosed late and developed ureterovaginal fistula.
Conclusion: Iatrogenic urinary tract injury is uncommon but carries serious morbidity. Adhesions due to previous surgery were an important risk factor