Publication:

Analysis of iatrogenic bladder injury in benign hysterectomy and risk factors in a tertiary care hospital

Background Hysterectomy is the most common major gynecological surgery, and iatrogenic bladder injury is the commonest visceral injury during the procedure. High morbidity, economic, and legal implications are expected if not diagnosed and managed intra-operatively. Though the high-risk factors increase the incidence of this complication in benign hysterectomy, it may occur without any risk factor. This study was aimed at finding the incidence of iatrogenic bladder injury in benign hysterectomy, the risk factors and their significance level, and to discuss the methods to avoid this complication.

Methods This retrospective observational cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Mamata Medical College and Hospital, Khammam, over four years, including all gynecological hysterectomy cases for benign indications, excluding obstetric and malignant cases. All the relevant data predicting iatrogenic bladder injury, and also no risk cases, were collected from the medical records of the institution. Statistical analysis was done by standard descriptive statistics, frequency tables, and percentages for categorical variables using Microsoft excel-2021. The significance of risk factors was assessed by calculating p values, ORs, and 95% CIs. A p<0.05 was considered significant.

Results Total abdominal hysterectomy (TAH) was the major approach (72.04%) of surgery. The overall incidence of bladder injury was 01.09%. and such injury occurred in 01.51% in TAH, as all the 19 cases of bladder injury occurred in this approach. The maximum number (n=11) of bladder injury occurred in post-caesarean cases (p=0.0041), followed by pelvic inflammation (n=06) with a p=0.0450.

Conclusions Thorough knowledge of regional anatomy, risk factor assessment, careful and sharp dissection, and supervision by a surgeon of high volume will reduce the incidence of bladder injury in hysterectomy for benign indications.