Urinary tract injury in laparoscopic-assisted vaginal hysterectomy.

STUDY OBJECTIVE

To evaluate the incidence and characteristics of urinary tract injury after laparoscopic-assisted vaginal hysterectomy (LAVH).

DESIGN

A retrospective study that evaluated all cases of urinary tract injury at the time of LAVH in an 11-year period. Parameters including surgical indication, site of injury, time of diagnosis, method of treatment, and long-term follow-up were analyzed. (Canadian Task Force classification II-2).

SETTING

Tertiary care university hospital.

PATIENTS

A total of 38 urinary tract injuries were found in 7725 LAVH.

INTERVENTION

LAVH and repair of urinary tract injuries with transvaginal or transabdominal approach.

MEASUREMENTS AND MAIN RESULTS

The incidence of urinary tract injury after LAVH was 4.9/1000 procedures: 3.9/1000 for urinary bladder injury and 1.0/1000 for ureteral injury. Prior cesarean section was the most common risk factor for bladder injuries. Ninety-six percent (29/30) of urinary bladder injuries were detected and treated during surgery. Half (4/8, 50%) of the ureteral injuries were identified during surgery. Of the 38 complications, 28 (75.7%) occurred in surgery.

CONCLUSION

Most urinary tract injuries in LAVH were identified during surgery and are associated with the surgeon's experience. Bladder injury can be repaired either transvaginally or abdominally; ureteral injury can be repaired abdominally.