Wong JMK, et al. - The researchers performed a comprehensive literature review of the incidence, location, etiology, timing, management, and long-term sequelae of urinary tract injury in gynecologic laparoscopy for benign indication. In this study, the incidence of lower urinary tract injury remained low at 0.33%. Compared to ureteral injury, bladder injury was 3 times more common, although ureteral injuries were more often unrecognized intraoperatively and underwent open surgical repair. These risk estimates could aid gynecologic surgeons in effectively performing preoperative counseling concerning the risks of lower urinary tract injury.

Methods

• Researchers conducted a systematic review of PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov.
• A total of 433 studies were screened for inclusion with 136 full-text articles reviewed.
• Inclusion criteria was met by 90 studies published from 1975 to 2015, representing 140,444 surgeries.
• They included articles reporting the incidence of urinary tract injury in gynecologic laparoscopy for benign indication.
• Malignancy, surgery by urogynecologists, research not in English, and insufficient data were the criteria for exclusion.

Results

• With an incidence of 0.33% (95% CI 0.30–0.36), a total of 458 lower urinary tract injuries were reported.
• Compared to ureteral injury (0.08%, 95% CI 0.07–0.10), bladder injury (0.24%, 95% CI 0.22–0.27) was overall 3 times more common.
• The highest rates of injury were observed with laparoscopic hysterectomy not otherwise specified (1.8%, 95% CI 1.2–2.6) and laparoscopically assisted vaginal hysterectomy (1.0%, 95% CI 0.9–1.2).
• Most ureteral injuries resulted from electrosurgery (33.3%, 95% CI 24.3–45.8).
• However, most bladder injuries resulted from lysis of adhesions (23.3%, 95% CI 18.7–29.0).
• In this study, ureteral injuries were identified, most often, postoperatively (60%, 95% CI 47–76) and were repaired by open ureteral anastomosis (47.4%, 95% CI 36.3–61.9).
• However, intraoperative recognition of bladder injuries was most often observed (85%, 95% CI 75–95); these were repaired by laparoscopic suturing (34.9%, 95% CI 29.2–41.7).