Our Summary
This research paper investigates the likelihood and risk factors for urinary tract injuries during a hysterectomy (surgery to remove a woman’s uterus), performed for non-cancerous reasons. The study uses data from California between 2005 and 2011.
Out of nearly 300,000 women who had a hysterectomy, about 1% had ureteral injuries (to the tubes that carry urine from kidneys to the bladder), 0.7% had bladder injuries, and 0.3% developed genitourinary fistulas (abnormal connections between the urinary tract and another organ).
The study found that if these injuries were identified and treated immediately, the likelihood of developing genitourinary fistulas was lower. Using a small tube (a stent) to keep the ureters open was particularly effective for injuries spotted straight away.
The research also identified several factors that increased the likelihood of urinary tract injuries during a hysterectomy. These include having a prolapse repair (fixing a fallen or slipping organ), an incontinence procedure (treatment for loss of bladder control), using mesh to support a prolapse repair, being diagnosed with endometriosis (a condition where tissue similar to the lining of the uterus grows in other places), and having surgery at a facility that performs fewer hysterectomies.
On the other hand, having a hysterectomy performed vaginally or laparoscopically (using a camera and small incisions) was linked to a lower chance of urinary tract injuries compared to an abdominal approach (cutting into the belly).
In conclusion, about 1.8% of women who undergo a hysterectomy for non-cancerous reasons experience urinary tract injuries. Detecting and treating these injuries promptly can lower the risk of developing further complications.
FAQs
- What percentage of women experience urinary tract injuries during a hysterectomy for non-cancerous reasons?
- What factors increase the likelihood of urinary tract injuries during a hysterectomy?
- How can the risk of developing genitourinary fistulas after a hysterectomy be reduced?
Doctor’s Tip
One helpful tip a doctor might tell a patient about hysterectomy is to discuss the potential risks and benefits of different surgical approaches, such as vaginal or laparoscopic versus abdominal. It is important for the patient to understand the potential for urinary tract injuries and other complications, as well as the factors that may increase the risk of these injuries. Additionally, the patient should be informed about the importance of prompt identification and treatment of any urinary tract injuries to minimize the risk of developing more serious complications like genitourinary fistulas.
Suitable For
Patients who are recommended hysterectomy for non-cancerous reasons may include those with conditions such as uterine fibroids, endometriosis, abnormal uterine bleeding, pelvic organ prolapse, or chronic pelvic pain. These conditions may be causing significant symptoms or complications that are not responding to other treatments. Additionally, patients who have completed their childbearing and do not wish to have more children may also be recommended hysterectomy as a definitive solution to their gynecological issues.
Timeline
Before a hysterectomy, a patient may experience symptoms such as heavy menstrual bleeding, pelvic pain, uterine fibroids, endometriosis, or prolapse. They may have undergone various diagnostic tests and consultations with their healthcare provider to determine if a hysterectomy is necessary.
After a hysterectomy, the patient will undergo surgery to remove their uterus. Depending on the type of hysterectomy performed (vaginal, laparoscopic, or abdominal), the recovery time and post-operative care may vary. Patients will typically experience pain, swelling, and discomfort in the days following surgery and will need to take time off work to rest and recover.
Over the following weeks and months, the patient will gradually resume normal activities and may experience improvements in their pre-existing symptoms. They may also need to attend follow-up appointments with their healthcare provider to monitor their recovery and address any concerns or complications that may arise.
Overall, a hysterectomy can have a significant impact on a patient’s physical and emotional well-being, and it is important for patients to be informed about the potential risks and benefits of the procedure before making a decision.
What to Ask Your Doctor
Some questions a patient should ask their doctor about hysterectomy in light of this research include:
- What is the likelihood of experiencing urinary tract injuries during a hysterectomy for non-cancerous reasons?
- What factors increase the risk of urinary tract injuries during a hysterectomy?
- How are urinary tract injuries typically identified and treated during a hysterectomy?
- What steps can be taken to prevent or minimize the risk of urinary tract injuries during a hysterectomy?
- How does the method of hysterectomy (vaginal, laparoscopic, abdominal) impact the risk of urinary tract injuries?
- What are the signs and symptoms of urinary tract injuries that I should watch out for after the surgery?
- How will my recovery be affected if I do experience a urinary tract injury during the hysterectomy?
- Are there any specific precautions or post-operative care instructions I should follow to reduce the risk of urinary tract injuries?
- What is the protocol for follow-up appointments or monitoring to ensure early detection of any urinary tract complications post-hysterectomy?
- Are there any alternative treatments or procedures that may be considered to reduce the risk of urinary tract injuries during a hysterectomy?
Reference
Authors: Dallas KB, Rogo-Gupta L, Elliott CS. Journal: Obstet Gynecol. 2019 Aug;134(2):241-249. doi: 10.1097/AOG.0000000000003353. PMID: 31306326