Management of Urinary Tract Injuries in Minimally Invasive Gynecologic Surgery

摘要

The urinary system's proximity to the female reproductive organs renders patients undergoing gynecologic surgery at increased risk for iatrogenic injury to the lower urinary tract (LUT). This includes the distal ureters, bladder, and urethra. Procedures such as oophorectomy, endometriosis resection, and all types of hysterectomy are common gynecologic surgical procedures in which these iatrogenic injuries can occur. Minimally invasive techniques have become the preferred approach to most gynecologic procedures. The laparoscopic approach has proven to be superior to traditional surgery in many ways, including shorter hospital stay, faster recovery time, and less blood loss. However, studies of LUT injuries sustained during laparoscopic hysterectomy have shown an increased incidence of injury comparable to that of an abdominal or vaginal approach. Therefore, there is an apparent gap between ideal and common practice, and it is vital for the surgeon using minimally invasive technique to be able to identify injuries and the steps to be taken if and when such injuries are encountered. Knowing when to consult an expert urologic surgeon to help in the management and repair of injury is also an important decision-making skill. The goal of this article is to address this gap in surgical practice.