Incidence, risk factors and morbidity of unintended bladder or ureter injury during hysterectomy

To determine the incidence, risk factors and morbidity of unintended operative injury to the bladder or ureter during hysterectomy, a retrospective case-control study of women with these injuries from 1 January 1993 to 1 January 1998 was performed. The incidence of bladder and ureter injury, respectively, was 0.58% and 0.35% for abdominal hysterectomy, 1.86% and 0% for vaginal hysterectomy, and 5.13% and 1.71% for hysterectomies performed for obstetric indications. Women with injury during abdominal hysterectomy were found to have greater blood loss, longer operative times, longer postoperative stays, more febrile morbidity, and more frequent transfusions. Similar trends were seen for other hysterectomy types. The incidence of operative bladder or ureter injury is relatively low. However, even when recognized, these individuals experience greater operative and postoperative morbidity. This highlights the importance of surgical technique directed toward minimization of these injuries, and careful intra- and postoperative surveillance aimed at early detection.