Iatrogenic urological lesions during gynaecological and obstetrical surgery at Cocody university hospital

Abstract

Objectives: To determine the epidemiological, clinical, therapeutic and evolving characteristics of iatrogenic urological lesions in our department.

Patients and method: We conducted a cohort study over a period of 3 years in the gynaecology and obstetrics department of the Cocody University Hospital. This was a non-exhaustive census of all patients who presented with an urological lesion.
 Results: 26 cases of iatrogenic urinary lesions were recorded, including 22 bladder lesions and 4 ureteral lesions. The patients were on average 29 years old, were multigravida (76.93%), multipara (61.54%) and presented an uterine scar (34.60%). The diagnosis was made during surgery in 96.16% of cases. Postoperative diagnosis was made in front of acute abdomen (3.84%). Caesarean section had caused a large number of iatrogenic urinary tract lesions (30.77%). The posterior surface of the bladder (59.09%) and the sub-ligamentum portion of the ureter (75%) were the most affected locations. The lesions of the bladder and ureter were repaired 
during surgery in 96.16%. Treatment consisted of extra mucous cystorrhaphy for the bladder (84.64%). For ureteral lesions, it was either end-to-end ureterorrhaphy (3.84%) or ureterostomy (3.84%) or suture ablation (3.84%). After surgery we observed complications in 15.36% of cases (n = 4) : urogenital fistula (50%), urinary tract infection (25%) and acute peritonitis (25%). The vesicovaginal fistula after cystorrhaphy took three months to be reopened, but the actual hospital stay was 50 days. The average stay of patients operated with iatrogenic urinary tract lesions was 15 +/- 12 days. We have not observed any decease.
Conclusion: We report a favorable management of cases of urological trauma during gynaecological and obstetrical surgery. Once rare, frequency is increasing  nowadays due to the multiplication of surgical interventions.