Urologic complications of laparoscopic radical hysterectomy and lymphadenectomy

• Published in: International Urogynecology Journal Vol. 23; no. 11; pp. 1605 - 1611
• Main Authors: Hwang, Jong Ha, Lim, Myong Cheol, Joung, Jae Young, Seo, Sang-Soo, Kang, Sokbom, Seo, Ho Kyung, Chung, Jinsoo, Park, Sang-Yoon
• Format: Journal Article
• Language: English
• Published: London Springer-Verlag 01-11-2012; Springer Nature B.V
• Subjects: Adenocarcinoma - surgery; Adult; Carcinoma, Squamous Cell - surgery; Endometrial Neoplasms - surgery; Female; Gynecologic Surgical Procedures; Gynecology; Humans; Hysterectomy - adverse effects; Iatrogenic Disease - epidemiology; Incidence; Lower Urinary Tract Symptoms - epidemiology; Lower Urinary Tract Symptoms - etiology; Lower Urinary Tract Symptoms - surgery; Lymph Node Excision - adverse effects; Medicine; Medicine & Public Health; Middle Aged; Original Article; Retrospective Studies; Stents; Urologic Diseases - epidemiology; Urologic Diseases - etiology; Urologic Diseases - surgery; Urology; Uterine Cervical Neoplasms - surgery; Laparoscopic radical hysterectomy; Urologic complications; Endometrial cancer; Cervical cancer
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-012-1767-2

Introduction and hypothesis
The purpose of this study was to evaluate the intra- and postoperative urologic complications and management in patients with cervical or endometrial cancer treated with laparoscopic radical hysterectomy and lymphadenectomy.
Methods
We retrospectively reviewed the medical records of 146 patients with cervical or endometrial cancer who underwent total laparoscopic radical hysterectomy with lymphadenectomy between August 2002 and April 2011. The intra- and postoperative urologic complications were analyzed.
Results
Double ureteral stents were inserted prophylactically in 13 patients (8.9 %), 2 of whom had postoperative urologic complications. Nine patients (6.2 %) had postoperative urologic complications. Of four patients with ureterovaginal fistulas, two were treated conservatively with cystoscopic placement of ureteral stents and two underwent ureteroneocystostomies. Vesicovaginal fistulas occurred in two patients, both of whom underwent vesicovaginal fistula repairs. One patient noted to have a bladder injury intraoperatively had a laparoscopic repair, and one patient noted to have a ureteral injury postoperatively was treated conservatively with cystoscopic placement of ureteral stents.
Conclusions
Iatrogenic lower urinary tract injuries during laparoscopic radical hysterectomy are relatively common complications. Intraoperative prophylactic ureteral stent insertion and the early detection of urologic complications postoperatively is advised for patients who undergo laparoscopic radical hysterectomies.