How prevalent are urinary tract injuries during gynecologic surgeries?

At the AUGS and IUGA 2022 Scientific Meeting in Austin Texas, Bethany Sampson, MD; and Oliver Daly, MD, of Western Health in Victoria, Australia, held a poster presentation, “Risky business—defining factors that contribute to urinary tract injuries in gynaecology,” highlighting the results of their study which aimed at identifying the prevalence of known risk factors for urinary tract injuries during major gynecological surgery. In their presentation they emphasized the need for addressing these injuries: one or more risk factors for urinary tract injury were found in more than half (57.2%) undergoing gynecologic surgery, while nearly 80% of patients who sustained a urinary tract injury had one or more risk factors for injury, with the most common risk factor being previous pelvic surgery. Additionally, the researchers acknowledged that although numerous studies retrospectively examine risk factors in patients who sustained injuries, they were unable to find any studies that examined the risks across all gynecological surgical patients, hence reinforcing the high-risk nature of this type of surgery.

The study was conducted at a single tertiary center from July 2019 through July 2020. Data was collected from operation notes and electronic medical records. Participants had undergone major gynecological surgery during the study time period, with risk factors of interest including BMI, past surgical history and surgical risk factors (such as endometriosis and pelvic inflammatory disease).

A total of 695 patients were identified for inclusion. Of these 695, one or more risk factors were found in 397 patients (57.1%). The patients recorded a mean BMI of 27. Other factors of note included previous caesarean sections (20.9%); previous laparoscopy (47.3%), previous hysterectomy (5.4%) and previous pelvic floor surgery (3.3%).

There were also surgical complexities found, including pelvic mass causing potential compression (4.3%); and known endometriosis (12.3%). Comparison made between total patients undergoing major surgery and previous data on urinary tract injuries was not significant. However, rate of risk factors amongst patients who sustained an injury was much higher in this study (76.9% v 49.1%)

The investigators noted that gynecology patients are at high risk for complications at surgery, considering rates of pelvic masses, concomitant pelvic disease and high rates of pelvic adhesions. The researchers also concluded that these risks are likely to increase as caesarean section rates increase, which can contribute to a rise in bladder rather than ureteric injuries.

The investigators concluded that it is crucial for physicians and their patients to consider these risks when planning these kinds of major surgery. As always, patient education is key.

Reference

Sampson B, Daly O. Risky business—defining factors that contribute to urinary tract injuries in gynaecology. Poster presentation at the 2022 American Urogynecologic Society and International Urogynecological Association’s 47th Annual Meeting. June 14-18, 2022. Austin, Texas.