Urological injury during surgery for malignant cancer

Abstract

Aim: This study was performed to analyze causes and types of urological injuries secondary to surgery for malignant cancer in a group of gynecological patients. Material and methods: From 1998 to 2017, 40 cases of urological injury secondary to gynecological operations were noted at the Department of Gynecology and Obstetrics of the Specialist Hospital in Radom, Poland. This group included 16 cases of injuries detected during and after surgery for malignant cancer (a total number of operations carrying a risk of urological injury: 851). Medical records of these patients were retrospectively analyzed. Results: Surgeries that led to urological injury were: hysterectomy with lymphadenectomy (4 cases, all after oncological surgery), hysterectomy (15 cases, 9 cases after oncological surgery), uterine body amputation (8 cases, 1 after oncological surgery), removal of ovarian tumor/rumors (4 cases, 2 after oncological surgery) and urogynecological surgery (9 cases). The following injuries occurred during gynecological surgery: ureteral and urinary bladder injury in 1 case (during oncological surgery), unilateral ureteral injury in 12 cases (8 during oncological surgery) and bladder injury in 18 cases (7 during oncological surgery). In urogynecological surgery, there were 8 cases of bladder wall injury and 1 case of urethral incision. In 1 case, it was required to remove the left kidney because of excision of a fragment of the ureter during hysterectomy with left salpingo-oophorectomy conducted due to ovarian cancer. In the remaining cases, the final outcomes of injury correction were favorable. Injuries that occurred in major gynecological procedures constituted the majority of urological injuries (27 cases, 67.5%). In this group, most of the surgeries (14, 51.9%) were conducted due to malignant genital cancer. Conclusions: Urological injury usually occurs during major gynecological surgery. In the group of oncological surgeries, ureteral injury with concomitant urinary bladder injury was the most common complication, observed in 1.06% of operated women. Patients at risk of urological complications, particularly those facing hysterectomy with salpingo-oophorectomy due to genital malignancy, should be adequately early referred to a reference center with resources to provide multidisciplinary medical care.