Abstract:

The urinary tract is at risk of injury during pelvic operations, such injuries may lead to urogenital fistula. Historically, regarding the approach for hysterectomy, the risk of ureteral injury appeared to be the greatest during laparoscopic hysterectomy. The most frequently accused pelvic operation is hysterectomies performed for benign gynecological reasons and is responsible for approximately 75% of vesicovaginal fistulas. The main reason for this experience in laparoscopy has been growing tremendously, recently. This study aims to evaluate the incidence, clinical presentation and etiological factors of urogenital fistula in laparoscopic and abdominal hysterectomy cases. The medical records of 1357 cases of laparoscopic and abdominal hysterectomy performed at Bagcilar Training and Research Hospital, Department of Obstetrics and Gynaecology between 1 January 2011 to 1 January 2016 was analysed retrospectively. All patients with diagnosis of ureterovaginal or vesicovaginal fistula were further evaluated. Seven cases (0.7%) of ürogenital fistula were secondary to abdominal hysterectomy and three cases (0.8%) of urogenital fistula were secondary to laparoscopic hysterectomy. We found no evidence that any choice of hysterectomy approach is superior to or inferior to the other techniques regarding formation of urogenital fistula. Although there are several studies for comparison of urinary tract injuries during abdominal and laparoscopic hysterectomy, debate continues regarding the safest approach for hysterectomy. While complications are inevitable, even in the hands of a skilled surgeon, they can be minimized by a sufficiently developed suturing technique and an excellent knowledge of pelvic anatomy.

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