Iatrogenic Urinary Tract Injuries in Surgical Procedures

Iatrogenic urinary tract injuries occur when surgical or medical interventions inadvertently damage the structures of the urinary system, most commonly the ureters and bladder. Such injuries may arise during a wide spectrum of abdominal, pelvic and gynaecological procedures, including hysterectomy, colorectal resections and caesarean section. Although their overall incidence is low—typically below 1%—these events carry significant morbidity, including urinoma formation, infection, renal impairment and prolonged hospital stay. Early recognition, ideally intraoperative, allows for prompt repair and minimises the need for extensive reconstructive surgery. Delayed diagnosis often leads to repeated interventions, additional hospital admissions and a protracted recovery. Advances in imaging, intraoperative fluorescence guidance and minimally invasive repair techniques have gradually improved detection and outcomes. Nevertheless, variation in prevention strategies and management protocols persists, underscoring the need for standardised guidelines and education in surgical anatomy.

Research from Nature Portfolio

A multicentre analysis of over a hundred patients treated for iatrogenic ureteral injury between 2001 and 2021 has highlighted that nearly half of these injuries were diagnosed only postoperatively. Delayed recognition was more frequent in younger patients and those undergoing benign laparoscopic hysterectomy. Such delays were associated with a significant rise in secondary procedures, extended hospital stays and multiple readmissions. Importantly, when injuries were identified intraoperatively, the majority of patients achieved full recovery after a single intervention. Over the two-decade study period, the overall incidence of ureteral injury remained stable, emphasising that improvements in surgical technique have yet to translate into a reduced complication rate.

Iatrogenic Urinary Tract Injuries in Surgical Procedures publication trend

The graph below shows the total number of articles in iatrogenic urinary tract injuries in surgical procedures across all publications each year (not limited to Nature Index journals).

Technical terms

Iatrogenic injury: Damage to an organ or tissue caused inadvertently by a medical or surgical procedure.

Ureterovaginal fistula: An abnormal connection between a ureter and the vagina, leading to continuous urinary leakage.

Intraoperative diagnosis: Identification of an injury or complication during the surgical procedure itself.

Laparoscopic hysterectomy: Removal of the uterus using minimally invasive keyhole techniques with a camera and specialised instruments.

Delayed diagnosis: Recognition of an injury only after the conclusion of the initial surgery, often necessitating additional interventions.

References

1. 2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery. World Journal of Emergency Surgery (2023).
2. A delayed diagnosis of iatrogenic ureteral injury results in increased morbidity. Scientific Reports (2024).
3. The efficacy of ureteroscopic triage in increasing the cure rate of the first-line treatment for a ureterovaginal fistula resulting from radical hysterectomy. Heliyon (2023).
4. Risk Factors for Urological Complications Associated with Caesarean Section—A Case-Control Study. Medicina (2022).