JİNEKOLOJİK CERRAHİ SONRASI ALT ÜRİNER SİSTEM YARALANMALARI: ERKEN TANI VE MULTİDİSİPLİNER ACİL YÖNETİM
Özet
Urinary tract injuries involving the bladder and ureters are uncommon but potentially serious complications of gynecologic surgery. Delayed recognition may result in urinary leakage, urinoma, urinary obstruction, infection, sepsis, fistula formation, loss of renal function, and the need for additional surgical procedures. Previous pelvic surgery, multiple cesarean deliveries, severe endometriosis, pelvic inflammatory disease, malignancy, radiotherapy, distorted pelvic anatomy, and extensive adhesions may increase the risk of injury. Early recognition is therefore a critical component of safe perioperative management.
Bladder injuries may be suspected intraoperatively in the presence of hematuria, visualization of the bladder mucosa, or urinary leakage during bladder filling. Ureteral injuries may occur through ligation, transection, crushing, devascularization, or thermal damage. Thermal injuries are particularly important because tissue necrosis and urinary leakage may become apparent only during the postoperative period. Unexplained flank or abdominal pain, fever, ileus, increased serum creatinine, hydronephrosis, persistent drainage, or continuous vaginal leakage following gynecologic surgery should raise suspicion of urinary tract injury.
Management depends on the location and extent of injury, timing of diagnosis, presence of obstruction or infection, and the patient’s clinical condition. Injuries recognized intraoperatively should be repaired whenever feasible. In delayed ureteral injuries, urinary diversion with ureteral stenting or percutaneous nephrostomy may be required before definitive reconstruction. Patients presenting with sepsis require prompt resuscitation, antimicrobial therapy, urinary decompression, and source control.
Optimal outcomes require timely collaboration among gynecologists and urogynecologists, urologists, radiologists, interventional radiologists, infectious disease specialists, and intensive care teams. Early diagnosis, appropriate urinary drainage, effective source control, and individualized reconstructive planning are the key principles for reducing morbidity after urinary tract injuries associated with gynecologic surgery.
Anahtar Kelimeler: gynecologic surgery, bladder injury, ureteral injury, urinary tract injury, urinary fistula, urogynecology, multidisciplinary management
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