Urinary Tract Injury During Gynecologic Procedures

Most urologic injuries that occur during gynecologic procedures are to the lower urinary tract. Laparoscopic hysterectomy is the most common surgery associated with lower urinary tract injury.

A large review in Finland found rates of urinary tract injury in laparoscopic hysterectomy of 22.8/1000. Urinary tract injury rates for trans abdominal hysterectomy and trans vaginal hysterectomy were 1.7/1000 and 0.4/1000, respectively (37). Unfortunately, the incidence of injury to the lower urinary tract has increased with the advent of new laparoscopic techniques (38). Hopefully, this number will decrease as surgeons gain more experience with advanced laparoscopic surgery.

The complexity of the laparoscopic procedure also increases the risk of injury to the lower urinary tract. The incidence of injury to the lower urinary tract after diagnostic laparoscopy is relatively low, less than 0.6/1000, whereas the risk of injury during operative laparoscopy was 3.0/1000. The majority of these injuries occurred during laparoscopic hysterectomy (39).

Injury to the urethra is unusual during laparoscopic gynecologic surgery.

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