Sangaré D, Berthé H J G, Diakité M L, Samassekou A, Diakité A S, Diallo M S, Koné O, Sissoko I, Dembélé I D, Coulibaly M T, Ouattara Z, Tembely A
Mali Med. 2018;33(2):9-12.
Bladder and ureteral lesions are the most common urologic complications occurring during pelvic surgery with 1% and 0.5% to 3%, respectively. These lesions are rarely recognized intraoperatively and pose a major problem to urologists, gynecologists, and general surgeons.
To study the factors favoring urologic complications following pelvic surgery at the University Hospital Point-G.
We conducted a retrospective study at the University Hospital Point-G between 2006 and 2015. It involved 23 patients with a whole urological lesion following pelvic surgery. These patients underwent a clinical and para-clinical examination (intravenous urography, methylene blue test) to confirm the urological lesion and to determine its management.
The average age of our patients was 32.00 years with extremes of 18 and 40 years old. The leakage of urine was found in 82.6% (19/23). Interventions that caused urologic injury were: caesarean section 52.2% (12/23), hysterectomy 30.4% (7/23), as well as a caesarean section and hysterectomy 17.4% (4/23). Methylene blue was performed in 19 patients, it was positive in 52.2% (12/23) and intravenous urography (IVU) in 7 patients. The lesions encountered were: retrotrigonal fistula vesico-vaginal 10 cases, vesico-vaginal fistula under trigonal 2 cases, uretero-vaginal fistula 7 cases, and bilateral ureteral ligation 4 cases. Fistulorraphy was performed in 52.2% followed by direct ureterovesical reimplantation. The postoperative outcome was satisfactory in 100% of cases with obtaining a good bladder tightness. The average duration of hospitalization was 12 days (+/- 4 days).
Pelvic surgery results in urological injuries. Caesarean section and hysterectomy are contributing factors. Vesico-vaginal fistula or ureteral lesions are common.
