The diagnosis and treatment of iatrogenic ureteral and bladder injury caused by traditional gynaecology and obstetrics operation.

摘要

To explore the etiologic factors and treatments of iatrogenic ureteral and bladder injury during obstetric and gynecologic operations.Forty-one patients who underwent traditional obstetric and gynecologic operations were found with iatrogenic ureteral and bladder injury, and recruited into our study. The etiologic factors and treatment for iatrogenic ureteral and bladder injury were analyzed retrospectively.Four cases of iatrogenic ureteral injury and five cases of iatrogenic bladder injury occurred in hysterectomy. Seven cases of iatrogenic ureteral injury and four cases of iatrogenic bladder injury occurred in subtotal hysterectomy for precancerous lesion. Five cases of iatrogenic ureteral injury and seven cases of iatrogenic bladder injury occurred in radical hysterectomy. One case of iatrogenic ureteral injury and eight cases of iatrogenic bladder injury occurred in cesarean section. Intra-operative ureteral injury in 11 patients was repaired by end-to-end anastomosis, and intra-operative bladder injuries in 19 patients were repaired during operation. In six patients the ureteral injury was found after operation, including three cases of ureterovaginal fistula, and the injury was repaired after resection of fistulas. These six cases all received ureteroesical anastomosis at early stage. Bladder injury was found in five cases after operation, and the injuries were repaired by closure of fistulas of bladder 3?months later. All cases recovered with no relapse during the follow-up period of 5?months to 1?year.Iatrogenic injury occurs during gynecologic surgery should be prevented first. Early discovery and effective treatments could bring good therapeutic effects.