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.

Urinary incontinence and pelvic organ prolapse in women with Marfan or Ehlers Danlos syndrome

OBJECTIVE

This study was undertaken to determine the prevalence of urinary incontinence and pelvic organ prolapse in a cohort of women with either Marfan syndrome or Ehlers-Danlos syndrome.

STUDY DESIGN

Female patients with either Marfan syndrome or Ehlers-Danlos syndrome were identified through a medical records search at two urban hospitals. Each patient's medical record was reviewed, and the history of pelvic organ prolapse and urinary incontinence was obtained through telephone interview.

RESULTS

Twelve women with Marfan syndrome were identified. Among these women 5 (42%) reported a history of urinary incontinence and 4 (33%) reported a history of pelvic organ prolapse. Eight women with Ehlers-Danlos syndrome were identified. Among these women 4 (50%) reported a history of urinary incontinence and 6 (75%) reported a history of pelvic organ prolapse.

CONCLUSIONS

Women with Marfan or Ehlers-Danlos syndrome have high rates of urinary incontinence and pelvic organ prolapse. This finding supports the hypothesized etiologic role of connective tissue disorders as a factor in the pathogenesis of these conditions.

Obstetric history in women with surgically corrected adult urinary incontinence or pelvic organ prolapse

STUDY OBJECTIVE

To compare obstetric histories of women who had surgical correction of urinary incontinence or pelvic organ prolapse with a similar group who did not.

DESIGN

Case control study (Canadian Task Force classification II-2).

SETTING

Urban, community-based, private practice teaching hospital.

PATIENTS

Four hundred eighty women (age 51.4 +/- 13.0 yrs) who underwent corrective surgery for urinary incontinence, pelvic organ prolapse, or both, and whose obstetric history was obtainable through chart review. The control group was composed of 150 women (age 50.7 +/- 9.6 yrs) having routine screening mammography who completed a questionnaire regarding obstetric, gynecologic, and urologic history.

MEASUREMENTS AND MAIN RESULTS

Patients and controls did not differ significantly in terms of age, race, height, weight, body mass index, or smoking history. Women who underwent surgery were of greater parity (2.5 +/- 1.2 vs 2.0 +/- 1.2, p <0.001), less often nulliparous (3% vs 18%, p <0.001), less likely to have had a cesarean delivery (4% vs 15%, p <0.001), and more likely to have had a vaginal delivery (94% vs 77%, p <0.001) than those with no surgery. The odds ratio of patients who had a vaginal delivery compared with controls was 4.7 (2.3-8.3), and that for cesarean delivery was 0.22 (0.11-0.43). Analysis of specific delivery information found that, compared with controls, patients were older by 4 years at time of their first delivery (28.9 +/- 4.9 vs 24.9 +/- 4.9 yrs, p <0.001) and more commonly received epidural analgesia intrapartum (87% vs 40%, p = 0.004). Comparisons within the patient group, categorized by indication for surgery, revealed that women who had surgery for either prolapse alone or for both prolapse and incontinence were most likely to have had vaginal deliveries (85% incontinence alone vs 94% prolapse alone vs 97% both, p <0.001).

CONCLUSION

Increased parity, vaginal childbirth, maternal age at time of delivery, and use of epidural analgesia are associated with need for operative correction of pelvic organ prolapse or adult urinary incontinence. Conversely, cesarean delivery is associated with less need for surgical correction of incontinence or pelvic organ prolapse.