Urological complications and management after gynecological operations

Aim: We aimed to evaluate the urological complications of gynecologic operations in a tertiary academic center and to evaluate the methods of treatment of these complications. Methods: Files of all patients, who underwent gynecological surgery between January 2016 and January 2019, were retrospectively reviewed from the hospital database. The patients with urological complications included in the study. Pediatric (<18 years old) patients, who underwent emergency surgery, and patients with incomplete medical records were excluded from the study. American Anesthesia Society score, menopausal status, body mass index (BMI), preoperative hemoglobin level, postoperative hemoglobin level, length of hospital stay and number of previous surgeries were recorded. In addition, the patients with urological complications were evaluated in terms of the indications for surgery, type of surgery, type of urological complication and the way of treatment of the complication. Results: After 79 patients were excluded according to exclusion criteria, of the 1754 patients who had undergone a gynecological operation, a total of 21 (1.19%) patients had urological complications and the bladder was the most common site of injury (61.9%). The mean age and mean BMI of the patients were 47.8 years and 25.25 kg/m², respectively. Urological complications occurred most commonly during staging surgeries due to ovarian or cervix cancer and during laparoscopic or abdominal hysterectomy due to large fibroids. When all operations were evaluated, bladder injury was the most common urological complication. Conclusion: Our study showed that urological complications during gynecological operations are rare (1.19%) and the most frequently injured organ is the bladder (61.9%). In addition, the risk of ureteral and renal injury increases in operations performed with the indication of malignancy and visualization of injuries is critical during operation and complication can be managed with variable techniques intraoperatively.