Exploring Urinary Tract Injuries in Gynecological Surgery: Current Insights and Future Directions

Abstract

Iatrogenic urinary tract injury is a known complication of pelvic surgery, most commonly occurring during gynecological procedures. The bladder and ureters are particularly vulnerable due to their close anatomical proximity to the uterus. Urinary tract damage can result from various mechanisms, including laceration, ligation, and thermal injury. Incidence rates vary according to the affected organ and surgical type; bladder injuries occur in 0.24% of benign and 0.4-3.7% of oncologic surgeries, whereas ureteral injuries are reported in 0.08% of benign and 0.39-1.1% of oncologic procedures. Timely diagnosis is essential for effective management. When detected intraoperatively, the injury can often be repaired immediately. Surgical treatment options vary depending on the specific nature and location of the bladder or ureteral damage. Delayed diagnosis can significantly impact the patient's quality of life, increasing the risk of severe complications such as genitourinary fistulas. This narrative review aims to summarize current evidence on the diagnosis, prevention, and treatment of urinary tract injuries occurring during gynecological surgery. It evaluates risk factors, incidence, management, complications, and prevention strategies for iatrogenic bladder and ureteral injuries. Additionally, it highlights the innovative role of artificial intelligence in preventing urologic damage during gynecological procedures. The relevant literature was identified through a structured search of the PubMed database using predefined keywords related to gynecological surgery and urinary tract injury.

Keywords: genitourinary fistula; hysterectomy; management; urinary injury.

Figure 1

Urinary tract fistulas. This schematic illustration shows the most common types of urinary fistulas involving the ureter and bladder in the female pelvis. The fistulas are named in the order in which they appear in the figure; from top to bottom: ureteral fistula, which is an abnormal connection between the ureter and an adjacent organ such as the uterus or bowel; uretero-vaginal fistula, a pathological tract between the ureter and the vagina; and vesicovaginal fistula, a direct communication between the bladder and vagina.