Wong JMK, et al. - A comprehensive literature review was performed on the incidence, location, etiology, timing, management, and long-term sequelae of urinary tract injury in gynecologic laparoscopy for benign indication. Observations revealed that in gynecologic laparoscopy for benign indication, the incidence of lower urinary tract injury remained low at 0.33%. Compared to ureteral injury, bladder injury was 3 times more common. However, ureteral injuries were more often unrecognized intraoperatively and underwent open surgical repair. Gynecologic surgeons could consider these findings in effectively counseling their patients preoperatively concerning the risks of lower urinary tract injury.

Methods

• Researchers performed a systematic review of PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov.
• With revision of 136 full-text articles, 433 studies were screened for inclusion.
• Inclusion criteria was met by 90 studies published between 1975 and 201, 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 included in the exclusion criteria.

Results

• Researchers identified 458 lower urinary tract injuries with an incidence of 0.33% (95% CI 0.30–0.36).
• Overall 3 times more frequent bladder injury (0.24%, 95% CI 0.22–0.27) was reported in comparison to the ureteral injury (0.08%, 95% CI 0.07–0.10).
• The highest rates of injury were evident 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).
• Electrosurgery resulted in most ureteral injuries (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).
• Mostly postoperative recognition of ureteral injuries was noticed (60%, 95% CI 47–76); these were repaired by open ureteral anastomosis (47.4%, 95% CI 36.3–61.9).
• However, intraoperative recognition of bladder injuries was mostly observed (85%, 95% CI 75–95) and these were repaired by laparoscopic suturing (34.9%, 95% CI 29.2–41.7).