Objective: • To determine the incidence of urinary tract injuries during gynecological surgeries. • To explore the role of universal cystourethroscopy to detect lower urinary tract injuries during gynecological operations to reduce postoperative morbidity and its sequelae.
Study design: A prospective observational study.
Settings: A tertiary care center.
Materials and methods: This was an observational study conducted in 163 women who underwent gynecological surgery at our department during August 2014 to May 2017.
Results: Data are classified according to demography, type, and indication of surgery performed in 163 consecutive subjects. History of previous pelvic surgery, if any, was taken into account to correlate with incidence of lower urinary tract injury intraoperatively. The ureteric and bladder injuries detected by routine intraoperative cystourethroscopy were tabulated. Intraoperatively detected rates of silent ureteric and bladder injury by cystourethroscopy are higher than obvious visually inspected injuries. We obtained intraoperatively ureteric injury rate of 0.61% and a bladder injury rate of 4.29% detected by cystourethroscopy. In two patients (1.23%), in spite of blood-stained urine in urobag, we could not detect any lower urinary tract injury. On long-term follow-up, two subjects (1.23%) attended outpatient department with ureterovaginal fistula and one subject (0.61%) developed vesicovaginal fistula.
Conclusion: Use of intraoperative universal cystourethroscopy during gynecological operations should be considered routinely to detect unsuspected lower urinary tract injuries and immediate management to prevent its long-term sequelae.
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