Urological Injuries during Obstetrical and Gynecological Surgeries

Object: Review the urological injuries encountered in gynecological and obstetrical procedures in respect of frequency, predisposing factors, location, recognition of time and management.Place and Duration: Department of Urology and Obstetrics and Gynecology at Peoples Medical College Hospital Nawabshah from 2007-2008.Study Design: Prospective study.Material and Methods: In this Prospective study of two (02) years 3400 obstetrical and gynecological surgeries were preformed. Medical records of all patients who sustained urological injuries were reviewed for frequency, predisposing factors, location, and type of injury, recognition time and management.Results: Thirty injuries were documented in 2930 obstetrical and 470 gynecological procedures. Twenty (20) injuries occurred in obstetrical procedures, where as 10 (ten) injuries occurred in gynecological surgeries. Twenty four (24) were bladder injuries, four (04) were ureteric injuries and two (02) were urethral injuries. The predisposing factors were previous C-Section, pelvic adhesions, huge fibroids, distorted anatomy and massive haemorrhage.Conclusion: These iatrogenic injuries were prevent-able by paying careful attention to anatomy of uro-genital organs, avoid blind application of clamps and excessive use of diathermy for haemostasis. These are due to delay of the patient, poor surgical monitoring facilities, improper training and supervision of post graduate trainees