Urological injuries in gynaecological practice--when is the optimal time for repair?

OBJECTIVE: This is a retrospective study to determine differences in outcome and prognosis between patients with urological injuries treated immediately within 30 days by definitive repair and those in whom definitive treatment was delayed.

SUBJECTS: Patients who sustained urinary tract injuries after gynaecological surgery and who were subsequently referred to the Urological Department of (former) Toa Payoh Hospital during the period 1985-1991.

RESULTS: There were nine injuries sustained in eight patients: six to the ureters and three to the bladder. One patient had a double injury: a vesico-vaginal fistula and a uretero-vaginal fistula. There were six patients whose injuries were repaired within 30 days of the primary gynaecological operation. They stayed an average of 10-14 days in hospital and were discharged well. They were well both clinically and radiologically on follow-up. Two patients had initial drainage before definitive surgery was undertaken. One patient recovered fully but had to endure the morbidity of a prolonged, 3-month hospital stay. The other patient treated by simple diathermy for her vesico-vaginal fistula, never fully recovered, and subsequently defaulted follow-up.

CONCLUSION: The old dictum of waiting 3 to 6 months to allow oedema to subside, tissue planes to be re-established and the fistula to become smaller, before repair is attempted, should be reviewed. Recently acquired fistulae may be repaired definitively soon after diagnosis of the problem, with good results in competent hands, as supported in this series of patients studied. This shortens the length of hospital stay for the patients and alleviates much of the morbidity endured.