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Objective: To identify clinical features of urinary tract injuries detected during or after gynecologic surgeries, with a specific focus on incidence and role of surgeon and surgical route on urinary injury. Study design: The institutional database from January 2009 to January 2017 was reviewed with respect to gynecologic (non-obstetric) surgeries and urinary injuries. Results: A total of 8719 gynecologic surgeries were identified. Of these, 46 (0.52%) were found to be complicated with a bladder (N=34, 0.38%), ureteral (N=11, 0.12%) and/or urethral injury (N=1, 0.01%). Bladder injuries occurred mostly at the superior part of the bladder, while ureteric injuries at the most distal part of the ureter. Ureteric injuries were mostly delayed (81.8% vs. 5.9%, P<0.001) and were more related to thermal injury than bladder injuries (45.5% vs. 8.8%, P=0.029). Among all surgical procedures, radical hysterectomy had the highest incidence for the ureteric injury (8.53%), while Burch colposuspension via minimally invasive route had the highest incidence for the bladder injury (16.6%). Cumulative incidence of urinary injury significantly differed according to the surgical route preferred (P=0.032), with the vaginal surgeries were associated with the highest incidence (0.96%). However, there was no such a difference in injury rates between the low-volume (0.55%) and high-volume (0.52%) surgeons (P=0.328) Conclusion: Overall incidence of lower urinary tract injury at gynecologic surgeries is low, does not differ according to annual number of surgeries performed, but increases with the vaginal surgeries.

Urinary Tract Injury at Gynecological Surgery: Results from a Tertiary-Care Institution