[Ureteral and bladder lesions after gynecologic surgery. Value of early diagnosis]. / Les lésions urétéro-vésicales après chirurgie gynécologique. Intérêt du diagnostic précoce.

ABSTRACT

Ureteric and bladder injuries are recognized complications of gynaecologic surgery. Efficiency of conservative treatments is directly related to early diagnosis. Urinary vaginal fistulas are easily diagnosed in view of post-operative continuous leakage. Ureteral or bladder obstructions can be quite asymptomatic and result in renal destruction or bladder impairment. Reviewing 17 cases, we emphasize abnormal post-operative pain and biological changes which must aware of urologic complications and lead to radiographic studies. Double-J stenting or bladder drainage associated with filling of fistula with fibrin sealant gives a chance of complete recovery to urogenital fistulas. Percutaneous nephrostomy or clean intermittent catheterisation preserves renal or bladder function until adequate treatment of obstruction has been defined.