OJU  Vol.5 No.12 , December 2015
Surgical Treatment of Urological Complications of Gynecological and Obstetric Surgeries at the University Hospital of Conakry Guinea
Abstract: Objective: To analyze the management of urological complications of gynecologic and obstetric surgeries. Material and Methods: We retrospectively studied 39 patients hospitalized in the Department of Urology of the Conakry Teaching Hospital for urological complications of gynecological surgery, during 9 years. The epidemiological, diagnostic, surgical and outcome parameters have been analyzed. Results: The urological complications of gynecologic surgery represent 0.29% of admissions in the Department of Urology. The mean age was 31 years with extremes of 18 and 47 years. Etiological factors were dominated by caesarean section with 74.36% of cases. The main lesions observed were vesico-vaginal and uretero-vaginal fistulas respectively 43.6% and 41.2% of cases. The mean delay of diagnosis was 5 months (extreme: 7 days to 3 years). Urine leakage from the vagina was the main symptom. The surgical treatment consisted in 17 surgeries for vesico-vaginal fistulas, 16 surgeries for uretero-vesical reimplantation, 2 surgeries for termino terminal ureterorraphia, 2 surgeries for vesico-uterine fistulas and 1 surgery for hysterectomy. Healing was obtained in all ureteral injuries and we noted two cases of failure in vesico-vaginal fistula. Conclusion: urological complications of gynecologic surgery remain frequent. They are dominated by the vesico-vaginal and uretero-vaginal fistulas and the main etiology is caesarean section. The treatment is surgical in our context.
Cite this paper: Diallo, A. , Sy, T. , Oury Diallo, T. , Bah, A. , Touré, A. , Bah, M. and Diallo, M. (2015) Surgical Treatment of Urological Complications of Gynecological and Obstetric Surgeries at the University Hospital of Conakry Guinea. Open Journal of Urology, 5, 231-237. doi: 10.4236/oju.2015.512037.

[1]   Asmussen, M. and Miller, A. (1983) Gynaecological Cancer Surgery and Lower Urinary Tract. In: Clinical Gynaecolo-gical Urology, Blackwell Scientic Publication, London, 119-150.

[2]   Bennani, S., Aboutaieb, R., El Mrini, M. and Benjelloun, S. (1994) Les traumatismes de l’uretère à propos de 29 cas. Journal d’Urologie, 100, 239-247.

[3]   Cussenot, O., Ferriere, X. and Le Duc, A. (1991) Lésions opératoires de l’uretère. Encycl Med Chir. Néphrologie-Urologie, 18160A10.

[4]   Goodno Jr., J.A., Powers, T.W. and Harris, V.D. (1995) Ureteral Injury in Gynecologic Surgery: A Ten Year Review in a Community Hospital. American Journal of Obstetrics & Gynecology, 172, 1817-1822.

[5]   Klbeanu, O.A., Chesson, R.R., Echols, K.T., Nieves, M., Busangu, F. and Nolan, T.E. (2009) Urinary Tract Injury during Hysterectomy Based on Universal Cystoscopy. Obstetrics & Gynecology, 113, 6-10.

[6]   Tostain, J. (1992) Les lésions urétéro-vésicales après chirurgie gynécologique: Intérêt du diagnostic précoce. Journal de Gynécologie, Obstétrique et Biologie de la Reproduction, 21, 519-523.

[7]   Freid, R.M. and Smith, A.D. (1993) Les complications de la chirurgie laparoscopique en urologie. Progres en Urologie, 3, 284-291.

[8]   Diallo, M.B., Diallo, A.T., Sow, K.B., Guirassy, S. and Diallo, I.S. (2001) Les complications urologiques de la chirur-gie gynécologique. A propos de 16 cas. Annales d Urologie, 35, 210-215.

[9]   Bouya, P.A., Odzébé, A.W., Otiobanda, F.G., Itoua, C., Mahoungou-Guimbi, K., Banga, M.R., et al. (2011) Les complications urologiques de la chirurgie gynécologique. Progres en Urologie, 21, 875-878.

[10]   El-Tabey, N.A., Ali-El-Dein, B., Shaaban, A.A., El-Kappany, H.A., Mokhtar, A.A., El-Azab, M., et al. (2006) Urological Trauma after Gynecological and Obstetric Surgeries. Scandinavian Journal of Urology and Nephrology, 40, 225-231.

[11]   Bennani, S., Aboutaieb, R., El Mrini, M. and Benjelloun, S. (1994) Les traumatismes de l’uretère à propos de 29 cas. Journal d’Urologie, 100, 239-247.

[12]   Fall, B., Diao, B., Sow, Y., Saar, A., Fall, P.A., Ndoye, A.K., et al. (2011) Les complications urinaires iatrogènes de la chirurgie pelvienne à ciel ouvert: Aspects lésionnels, thérapeutiques et les facteurs pronostiques. Dakar Medical, 56, 224-228.

[13]   Odzebe, A.W.S., Bouya, P.A., Itoua, C., Odiobongo, G.F., Mahoungou Guimbi, K., Banga, M.R., et al. (2011) Les traumatismes urétéraux. Revue Africaine d’Anesthesie Reanimation et de Medecine d’Urgence, 16, 45-46.

[14]   Chapron, C., Dubuisson, J.B., Ansquer, Y. and Fernandez, B. (1998) Hystérectomie totale pour pathologies bénignes: La coeliochirurgie ne semble pas majorer le risque de complications. Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 27, 55-61.

[15]   Tanoh, L., Anongba, D., Kone, N. and Bohoussou, K. (1997) étude des complications de la césarienne dans un Centre de référence: La maternité de Cocody. Guinée Médicale, 15, 23-26.

[16]   Rajasekar, D. and Hall, M. (1997) Urinary Tract Injuries during Obstetric Intervention. British Journal of Obstetrics and Gynaecology, 104, 731-734.

[17]   Tazi, M.F., Ahallal, Y., Ahsaini, M., El Fassi, M.J. and Farih, M.H. (2010) Plaies vésicales d’origine gynéco-obstétricale: Mise au point à propos de vingt cas. Journal Marocain d’Urologie, 17, 17-21.

[18]   Faricy, P.O., Augspurger, R.R. and Kaufman, J.M. (1978) Bladder Injuries Associated with Cesarean Section. The Journal of Urology, 120, 762-763.

[19]   Body, G. and Lansac, J. (1986) Complications précoces de l’intervention de Wertheim pour cancers de l’utérus. La Lettre Chirurgicale, 31, 6-8.

[20]   Jozwik, M. and Jozwik, M. (1999) Spontaneous Closure of Vesico-Uterine Fistula. Account for Hormonal Treatment. Urologia Internationalis, 62, 183-187.

[21]   Kumar, A., Vaidyanathan, S., Sharma, S.K., Sharma, A.K. and Goswami, A.K. (1988) Management of Vesico-Uterine Fistulae: A Report of Six Cases. International Journal of Gynecology & Obstetrics, 26, 453-457.

[22]   Benchekroun, A., Lachkar, A., Soumana, A., Farih, M.H., Belahnech, Z., Marzouk, M. and Faik, M. (1999) Les fistules vésico-utérines: A propos de 30 cas. Annales d’Urologie, 33, 75-79.

[23]   Klap, J., Phé, V., Chartier-Kasteler, E., Mozer, P., Bitker, M.O. and Roupret, M. (2012) étiologie et traitements des plaies iatrogènes de l’uretère: Analyse de la littérature. Progrès en Urologie, 22, 913-919.

[24]   Preston, J.M. (2000) Iatrogenic Ureteric Injury: Common Medicolegal Pitfalls. BJU International, 86, 313-317.

[25]   Han, C.M.T.H., Kay, N., Wang, C.J., Su, H., Yen, C.F. and Lee, C.L. (2012) Outcome of Laparoscopic Repair of Ureteral Injury: Follow-Up of Twelve Cases. Journal of Minimally Invasive Gynecology, 19, 68-75.

[26]   Murthy, P.V., Rao, H.S., Meherwade, S., Rao, P.V., Srivastava, A. and Sasidharan, K. (1997) Ureteroscopic Lithotripsy Using Mini-Endoscope and Swiss Lithoclast: Experience in 147 Cases. Journal of Endourology, 11, 327-330.

[27]   Brandes, S., Coburn, M., Armenakas, N. and McAninch, J. (2004) Diagnosis and Management of Ureteric Injury: An Evidence-Based Analysis. BJU International, 94, 277-289.

[28]   Martin, X., Ndoye, A., Konan, P.G., Feitosa Tajra, L.C., Gelet, A., Dawahra, M., et al. (1998) Complications de l’urétéroscopie lombaire: A propos de 4 cas d’avulsion de l’uretère. Progrès en Urologie, 8, 358-362.

[29]   Ostrzenski, A., Radolinski, B. and Ostrzenska, K.M. (2003) A Review of Laparoscopic Ureteral Injury in Pelvic Surgery. Obstetrical & Gynecological Survey, 58, 794-799.

[30]   Wolff, B., Chartier-Kastler, E., Mozer, P., Haertig, A., Bitker, M.O. and Rouprêt, M. (2011) Long-term Functional Outcomes after Ileal Ureter Substitution: A Single-Center Experience. Urology, 78, 692-695.