INTRAOPERATIVE IATROGENIC URETHRAL INJURIES IN WOMEN: DIAGNOSIS AND MANAGEMENT OF EARLY AND LONG-TERM CONSEQUENCES

Background. Iatrogenic urethral injuries in women, occurring during vaginal surgeries and transurethral manipulations, represent a serious problem, as their untimely or inadequate correction leads to the formation of urethral strictures and urethro-vaginal fistulas. An important link in the pathogenesis is the concomitant damage to the paraurethral glands (Skene's glands), which exacerbates inflammation and impedes repair. Objective: to demonstrate the features of diagnosis and management tactics for patients with early and long-term consequences of iatrogenic urethral injuries on the basis of clinical observations. Material and methods. The study included 42 female patients divided into two groups. Group I (n=31) consisted of patients with intraoperatively diagnosed urethral injuries (12 with penetrating injuries during vaginal surgeries, 19 with non-penetrating injuries during endourethral manipulations). Group II (n=11) consisted of patients with longterm consequences of undiagnosed injuries in the form of urethral stricture (n=6) or urethro-vaginal fistula (n=5). Results. In Group I, all injuries were successfully corrected: penetrating defects were sutured with urethral catheter drainage for 5-6 days, non-penetrating injuries required catheterization for 5-7 days. No complications or recurrences were observed during the follow-up period of 4-8 months. In Group II, urethral strictures were successfully treated with bougienage, and urethro-vaginal fistulas were treated surgically using an original technique of urethral verticalization to facilitate fistuloplasty. Fistula recurrence was noted in one case with subsequent development of a stricture. Conclusions. Timely intraoperative diagnosis and adequate primary correction of urethral injuries prevent the development of severe long-term complications. Key preventive methods are urethral catheterization during vaginal surgeries and strict adherence to the technique of endourethral interventions.