potential complications of gynaecologic surgery

see also:

• gynaecology

• depending upon the type of procedure, potential local complications of surgery include:
  • UTI
  • urinary retention
  • uterine issues
    • vault haematoma post-hysterectomy
    • uterine perforation
    • retained products of conception / endometritis
    • cervical incompetence
    • cervicitis
  • bladder trauma including formation of vesicovaginal fistulae
  • ureter issues including injury or suturing
  • urethral issues

• see also:
  • AJOG Global Reports Volume 2, Issue 3, August 2022 Best practices for repair of iatrogenic bladder injury
• urinary tract infection following catheterisation
• urinary retention
• urinary tract injuries occur in 0.3% to 0.8% of all gynecologic procedures, and injuries to the bladder occur in 0.05% to 0.66% of such surgeries.
• injury to the bladder, particularly a mechanical injury, is more common than injury to the ureter
• most bladder injuries are recognized during surgery
• cystoscopy detects nearly all unrecognized bladder and ureteral injuries
• bladder injuries can be characterized as intra- or extraperitoneal and may include sharp instrument trauma, perforation, placement of suture into the bladder:
  • Grade 1: contusion, intramural hematoma, or partial thickness laceration
  • Grade 2: extraperitoneal bladder wall laceration <2 cm
  • Grade 3: extraperitoneal >2 cm or intraperitoneal <2 cm bladder wall laceration
  • Grade 4: intraperitoneal bladder wall laceration >2 cm
  • Grade 5: intra- or extraperitoneal bladder wall laceration involving the trigone or bladder neck
  • extraperitoneal injuries can be further classified:
    • open pelvic fracture with exposed bone within the bladder lumen
    • concurrent rectal or vaginal injury to prevent subsequent fistula formation to the bladder
    • bladder neck injury
    • persistent haematuria as a consequence of the bladder injury, with clots interfering with adequate bladder drainage
  • grade 1 and 2 injuries are generally managed with 7-14 days (although some need 21 days to heal) IDC
• risk of bladder injury increases in hysterectomy procedures
  • 1.0% to 1.8% in laparoscopically assisted vaginal hysterectomies and vaginal hysterectomies
• injury to the bladder can occur at several points in gynecologic or obstetric surgery:
  • during lysis of adhesions
  • bladder dissection in all routes of hysterectomy
  • entry into the anterior cul-de-sac in a vaginal hysterectomy
  • when using a suprapubic incision for trocar placement or tissue extraction
  • urethral sling placement is a particularly high-risk procedure for bladder injury, which complicates between 3% and 9% of procedures and also risks urethral perforation on 0.4-1%
  • caesarean deliveries, esp. vertical midline subumbilical incisions
  • thermal spread from electrosurgical energy can lead to delayed injury

• earlier menopause and perhaps more severe reduction in hormonal levels
  • hysterectomy may result in lower ovarian sex steroid levels, resulting in earlier menopause
  • oophorectomy can reduce premenopausal serum oestradiol by up to 80% and androgen levels by about 50% in both premenopausal and postmenopausal women
• increased osteoporosis risk
• increased stroke risk
  • women of reproductive age have a lower stroke risk, whereas postmenopausal women are roughly two times more likely to have a stroke within a decade of menopause
  • a 2025 study using data from the National Health and Nutrition Examination Survey (NHANES) included more than 21,000 women showed:¹⁾
    • 18% higher risk of stroke for hysterectomy with bilateral oophorectomy
    • 5% higher risk of stroke for hysterectomy alone