Department of Obstetrics and Gynecology, University of Southern Denmark, Odense University Hospital, Region of Southern Denmark, Odense, Denmark.
Arch Gynecol Obstet. 2023 Feb;307(2):511-518. doi: 10.1007/s00404-022-06800-0. Epub 2022 Oct 1.
Ureteral injuries are often associated with complications and risk of fistula especially in case of malignancy. Length of catheterization should be reconsidered according to the injury.
Iatrogenic urinary tract injuries are potential complications of gynecologic and obstetric surgery. Our aim was to describe suture type and size, length of urethral catheterization, length of hospitalization, reoperation rate, follow-up, and impact on quality of life following iatrogenic bladder and ureteral injury.
In total, 81 women met inclusion criteria. Bladder injuries included 55 women, ureteral injuries in 23 women, and three women had bladder and ureteral injuries.
Most bladder injuries were managed by a two-layer suture followed by transurethral catheterization for 11.4 days (95% CI 9.1-13.6). The most frequent suture type was 3.0 Vicryl in all subgroups. In total, 30.4% of ureteral injuries were managed by neoimplantation followed by ureteral stenting for 38.0 days (95% CI 22.0-54.0) and transurethral catheterization for 16.9 days (95% CI 5.3-28.4), or by ureteral stenting for 46.7 days (95% CI 31.5-61.2) and transurethral catheterization for 6.25 days (95% CI 1.0-13.5). Altogether, 25 (30.9%) women underwent a reoperation mostly due to ureteral injury (68%). In total six women developed a fistula, of whom five had malignant surgery. Multiple linear regression showed a statistically significant increased median length of urethral catheterization when the duration of surgery increased.
Our study demonstrates a high reoperation rate, and a high fistula rate in case of malignancy. Length of catheterization was high even in case of benign surgery, however, only one woman developed a fistula in the benign group, suggesting a reduction in catheterization length.
输尿管损伤常伴有并发症和瘘管风险，尤其是恶性肿瘤。应根据损伤情况重新考虑导尿管留置时间。
医源性泌尿道损伤是妇科和产科手术的潜在并发症。我们的目的是描述缝合类型和大小、尿道导管插入的长度、住院时间、再次手术率、随访情况以及医源性膀胱和输尿管损伤对生活质量的影响。
共有 81 名女性符合纳入标准。膀胱损伤 55 例，输尿管损伤 23 例，膀胱和输尿管损伤 3 例。
大多数膀胱损伤采用双层缝合，随后经尿道导尿管留置 11.4 天（95%置信区间 9.1-13.6）。所有亚组最常见的缝合类型均为 3.0 薇乔。共有 30.4%的输尿管损伤采用新植入物治疗，随后输尿管支架留置 38.0 天（95%置信区间 22.0-54.0）和经尿道导尿管留置 16.9 天（95%置信区间 5.3-28.4），或输尿管支架留置 46.7 天（95%置信区间 31.5-61.2）和经尿道导尿管留置 6.25 天（95%置信区间 1.0-13.5）。共有 25 名（30.9%）女性接受了再次手术，主要是由于输尿管损伤（68%）。共有 6 名女性发生瘘管，其中 5 名有恶性手术。多元线性回归显示，手术时间延长时，尿道导尿管留置的中位数明显延长。
我们的研究表明，再次手术率高，恶性肿瘤患者瘘管发生率高。即使是良性手术，导尿管留置时间也很长，但良性组只有 1 名女性发生瘘管，提示可以减少导尿管留置时间。
