Urethral injury during vaginal delivery: Incidence, management and long-term outcomes

This study examines the incidence, obstetric risk factors, surgical management, and long-term outcomes of obstetric-associated urethral injuries during vaginal deliveries.

A retrospective case series was conducted at a single, tertiary university-affiliated medical center between January 2018 and December 2023. Demographic, obstetric, and surgical data were retrieved from the hospital's electronic records. Validated symptom questionnaires (BFLUTS, USIQ, and MESA) were administered prospectively at ≥18 months postpartum.

Of 59 553 vaginal deliveries, five urethral injuries were identified, equivalent to 0.83 per 10 000 vaginal deliveries. Injuries comprised urethral tear or complete detachment of the urethra. One injury followed vacuum-assisted delivey, one occurred during precipitated labor, and three during uncomplicated spontaneous vaginal deliveries. Two patients also exhibited significant symphyseal diastasis. Four cases were diagnosed immediately after delivery, and one other case was diagnosed several hours after delivery due to anuria. All cases were managed in the operating room by a senior urologist. At a mean follow-up of 42 months (range 18-83), questionnaire scores were low (BFLUTS 2.0 [1.0-16.5], USIQ 0 [0-37.5], MESA stress ratio 14.1 [2.35-94.1]). No patients reported other long-term sequelae associated with urethral trauma, such as urethral stricture or urethrovaginal fistula. At follow-up, two patients had given birth again; both underwent uncomplicated vaginal deliveries.

Urethral injury during vaginal delivery is rare. Early diagnosis and immediate surgical repair were associated with favorable long-term lower urinary tract symptoms. Concomitant symphyseal diastasis in two patients may suggest clinical association. Further studies are needed to establish management guidelines.