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  • Title: Urinary tract injury in laparoscopic-assisted vaginal hysterectomy.
    Author: Soong YK, Yu HT, Wang CJ, Lee CL, Huang HY.
    Journal: J Minim Invasive Gynecol; 2007; 14(5):600-5. PubMed ID: 17848321.
    Abstract:
    STUDY OBJECTIVE: To evaluate the incidence and characteristics of urinary tract injury after laparoscopic-assisted vaginal hysterectomy (LAVH). DESIGN: A retrospective study that evaluated all cases of urinary tract injury at the time of LAVH in an 11-year period. Parameters including surgical indication, site of injury, time of diagnosis, method of treatment, and long-term follow-up were analyzed. (Canadian Task Force classification II-2). SETTING: Tertiary care university hospital. PATIENTS: A total of 38 urinary tract injuries were found in 7725 LAVH. INTERVENTION: LAVH and repair of urinary tract injuries with transvaginal or transabdominal approach. MEASUREMENTS AND MAIN RESULTS: The incidence of urinary tract injury after LAVH was 4.9/1000 procedures: 3.9/1000 for urinary bladder injury and 1.0/1000 for ureteral injury. Prior cesarean section was the most common risk factor for bladder injuries. Ninety-six percent (29/30) of urinary bladder injuries were detected and treated during surgery. Half (4/8, 50%) of the ureteral injuries were identified during surgery. Of the 38 complications, 28 (75.7%) occurred in surgery. CONCLUSION: Most urinary tract injuries in LAVH were identified during surgery and are associated with the surgeon's experience. Bladder injury can be repaired either transvaginally or abdominally; ureteral injury can be repaired abdominally.
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