URINARY-TRACT INJURIES AFTER HYSTERECTOMY

Objective: To evaluate the nationwide incidence and characteristics of urinary tract injuries after laparoscopic hysterectomy, total abdomin al hysterectomy, supracervical abdominal hysterectomy, and vaginal hys terectomy. Methods: We analyzed retrospectively 142 urinary tract inju ries after hysterectomy, reported to the National Patient Insurance As sociation in Finland from 1990 through 1995. The Finnish Hospital Disc harge Register collects data on procedures from all hospitals, and 62, 379 hysterectomies were carried out during the study period. Results: The total incidence of ureteral injury after all hysterectomies was 1. 0 of 1000 procedures: 13.9 of 1000 after laparoscopic, 0.4 of 1000 aft er total abdominal, 0.3 of 1000 after supracervical abdominal, and 0.2 of 1000 after vaginal hysterectomy. Difficulties during an operation with a ureteral injury were encountered in 51%, 76%, 100%, and 100%; t he failure rates of primary repair of a ureteral injury were 5%, 12%, 0%, and 0%; and the convalescence times after a ureteral injury were 8 6 days, 94 days, 71 days, and 47 days after laparoscopic, abdominal, s upracervical abdominal, and vaginal hysterectomies, respectively. The incidence of bladder injury was 1.3 of 1000 procedures. Sixty-five per cent of reported bladder injuries were fistulas, giving an incidence o f vesicovaginal fistula of 0.8 of 1000 procedures after all hysterecto mies: 2.2 of 1000 after laparoscopic, 1.0 of 1000 after total abdomina l, 0 of 1000 after supracervical abdominal, and 0.2 of 1000 after vagi nal hysterectomy. Difficulties during an operation with a bladder inju ry were encountered in 53%, 37%, 100%, and 0%; the failure rates of pr imary repair of a simple bladder injury were 5%, 18%, 0%, and 0%; the failure rates of primary repair of a vesicovaginal fistula were 17%, 2 0%, 0%, and 0%; and the convalescence times after a bladder injury wer e 51 days, 118 days, 71 days, and 99 days after laparoscopic, abdomina l, supracervical abdominal, and vaginal hysterectomy, respectively. Co nclusion: The risk of ureteral injury is higher after laparoscopic hys terectomy compared with traditional hysterectomies. (Obstet Gynecol 19 98;92:113-8. (C) 1998 by The American College of Obstetricians and Gyn ecologists.).