Urological complications following obstetric- gynecologic procedures at Sanglah General Hospital, Bali-Indonesia

Background: Surgical complications are often inevitable despite advances and improvement in surgical skills and science. Objective: We performed a study to investigate the clinical features of urological injury following obstetric and gynecologic procedures. Methods: We identified the urological complications which arose during or following obstetric-gynecologic procedures at Sanglah General Hospital, Bali from January 2014 to July 2017. The retrospective data retrieved included details of the procedures, the sites of injury, the treatments, and the outcomes. Results: We had 41 patients with urologic complications following obstetric and gynecologic procedures. According to the medical records, 14 had a bladder injury, 6 had a ureteral injury, 3 had both bladder and ureteral injuries, 16 had a vesicovaginal fistula, and 2 had a ureterovaginal fistula. A total abdominal hysterectomy was the most common procedure underlying complications. The second most common was radical abdominal hysterectomy. All cases of bladder injury underwent a primary suturing during surgery without complications. Where the ureter was injured, 2 patients underwent primary suturing, 5 underwent Boari flap technique, 2 underwent end-to-end anastomosis, and 2 underwent laparoscopic ureteroneocystostomy. Vesicovaginal fistula (VVF) was mostly managed using the transvaginal approach with a tissue flap. The overall success rate of VVF repair was 75% after a primary repair. Conclusion: Bladder injuries were the most common urological injury during obstetric and gynecologic procedures. VVF management with various surgery techniques yields a good result.