Incidence, Detection, and Management of Urological Injuries in Obstetric and Gynecologic Surgeries: A Five-Year...

Urological injuries are rare but significant complications of obstetric and gynecologic procedures, associated with morbidity, prolonged hospital stay, and medicolegal implications. Bladder injuries are typically identified intraoperatively, while ureteric injuries are often delayed presentation. Early recognition and prompt management are critical to reduce complications. The study aimed to evaluate the incidence, type, timing of detection, management, and outcomes of urological injuries in patients undergoing obstetric and gynecologic surgeries.

This retrospective and prospective study included 15,697 procedures (6150 gynecologic surgeries, 9547 lower segment cesarean sections) performed from January 2020 to December 2024 at a tertiary care center. Intraoperative and postoperative urological injuries were recorded and classified as early (≤7 days) or late (>7 days). Management strategies included primary repair, endoscopic procedures, stenting, or ureteric reconstruction. Descriptive statistics summarized patient demographics, injury rates, and outcomes. Comparisons were performed using chi-square and t-tests, with p <0.05 considered significant.

Urological injuries occurred in 43 (0.27%) procedures; bladder injuries in 34 (0.21%), ureteric injuries in 7 (0.04%), and combined injuries in 2 (0.01%). Bladder injuries were slightly more frequent during obstetric procedures 22 (0.23%) compared to gynecologic procedures 12 (0.19%), whereas ureteric injuries occurred only in gynecologic surgeries 7 (0.11%). Most injuries 33 (76.7%) were detected intraoperatively. Intraoperative bladder injuries were repaired primarily with suprapubic cystostomy, and ureteric injuries underwent uretero-neocystostomy or ureteroureterostomy. Early recognition facilitated effective management and favorable outcomes, with mean hospital stay ranging from four to 12 days depending on injury type and timing.

Urological injuries are uncommon but clinically important. Early intraoperative detection and tailored surgical management ensure optimal outcomes. Preventive strategies, including meticulous surgical technique and careful intraoperative assessment, are essential to minimize morbidity.