J. Hategekimana1, T. Hategekimana1,2, A. Bonane1,2, H. Wood5, I. Nzeyimana1, A. Nyirimodoka1,3,4 1National University Of Rwanda, College Of Medicine And Health Sciences, Kigali, KIGALI, Rwanda 2Kigali University Teaching Hospital, Department Of Urology, Kigali, KIGALI, Rwanda 3Rwanda Military Hospital, Department Of Urology, Kigali, KIGALI, Rwanda 4King Faisal Hospital Rwanda, Department Of Urology, Kigali, KIGALI, Rwanda 5Glickman Urological Institute, Glickman Urological Institute, Cleveland, CLEVELAND, USA
Introduction: Urologic injuries occur frequently during surgery in the pelvic cavity. Female urogenital tracts are closely related and are associated with injuries during GO (Gynecology and Obstetrics) operations. Failure to recognize urinary tract during GO operations can lead to injuries associated with devastating consequences including increased morbidity and long term complications such as urogenital fistula and renal function loss. The objective of this study was to determine the incidence, risks, management options and outcome of urologic injuries caused by gynecological and obstetrics (GO) surgery in CHUK.
Methods: This was a retrospective study with chart reviews conducted for all patients who underwent surgery for post iatrogenic urological injuries following obstetrics and gynecological surgery from 2011-2018. We described surgical approaches, causative illness, treatment options, and outcomes of care using frequency and percentages and described relationships using fisher’s exact test.
Results: A total of 13,858 major surgeries and cesarean sections combined were performed at CHUK in the department of Obstetrics and Gynecological. 89 patients were recorded to have iatrogenic urological injuries in the study period accounting for incidence rate of 0.6%. Incidence rate of bladder and ureter injuries account for 0.42% and 0.22% respectively. Cesarean section was the most common surgery resulting in urological injuries 64(71.1%) followed by TAH with 19(21.3%).Uterine rupture was the most common known indication of surgery accounting for 23(25.84%), followed by Abnormal labor 18(20.22%). Among 89 patients, 62(69.7%) of patients who presented with iatrogenic urologic injuries were operated by General Practitioners, 11(12.4%) by Gynecologists, 7(7.9%) by Residents in GO. Treatment accorded: 67(75.2%) cases of bladder and VVF injuries were repaired and 27 (30.3%) cases of ureteral injuries were reimplanted on JJ stent. Regarding outcomes, 62(69.7%) were healed with no sequelae while 23(25.8%) healed with sequelae.
Conclusion: The frequency of iatrogenic urologic injuries and management outcomes following Gynecology and obstetrics surgery are worrisome and require medical attention. The competency of General practitioners, residents in GO, midwives, nurses has to be reinforced and maintained by regular trainings on female urogenital tracts safe surgery and labor monitoring to minimize risks.