UROGYNECOLOGICAL AN UROLOGICAL COMPLICATION FOLLOWING HYSTERECTOMY – EPIDEMIOLOGY, RISK FACTORS, PREVENTION AND TREATMENT WITH SPECIAL EMPHASIS URETERAL INJURY AND VESICOVAGINAL FISTULAS
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5821Keywords:
Hysterectomy, Urinary Incontinence, Ureteral Injury, Vesicovaginal Fistula, Indocyanine Green, UrogynecologyAbstract
Introduction: Hysterectomy remains one of the most frequently performed gynecological procedures and, despite advancements in surgical techniques, it is still associated with the risk of late complications affecting both pelvic floor function and the urinary tract. The most commonly reported consequences include stress urinary incontinence, pelvic organ prolapse, and urinary retention, while less frequent—but clinically more severe—consequences include ureteral injury, bladder trauma, and vesicovaginal fistulas.
Objective: The aim of this study was to review current literature regarding the epidemiology, pathophysiology, risk factors, prevention, and treatment of urogynecological and urological complications following hysterectomy, with a particular focus on ureteral injuries and vesicovaginal fistulas.
Methodology: A systematic narrative literature review was conducted in accordance with PRISMA 2020 guidelines. Searches were performed in PubMed, Scopus, and the Cochrane Library, as well as current clinical guidelines from medical societies between 2015 and 2026. The analysis included clinical trials, cohort studies, systematic reviews, meta-analyses, and guidelines regarding complications after hysterectomy and their prevention and treatment.
Key risk factors included advanced age, obesity, multiparity, adhesions, endometriosis, prior pelvic surgeries, and procedures requiring extensive tissue dissection. Evidence suggests that pelvic floor muscle prehabilitation may reduce some late functional disorders, and minimally invasive techniques improve surgical field visibility, facilitating conservative dissection of anatomical structures. In high-risk operations, intraoperative cystoscopy effectively detected ureteral obstruction, while indocyanine green (ICG) fluorescence facilitated assessment of the ureteral course and perfusion during complex hysterectomies. Urinary tract injury significantly increased the risk of subsequent vesicovaginal fistula, the incidence of which following hysterectomy performed for benign conditions was estimated at approximately 0.11%.
Conclusions: Complications after hysterectomy encompass both common urogynecological disorders and rarer, yet more severe, urinary tract injuries. Proper patient assessment, prehabilitation, selection of appropriate surgical technique, and selective use of intraoperative control methods, such as cystoscopy and ICG in high-risk groups, are of the greatest practical importance. In Poland, there is a need for better registry data and further evaluation of the effectiveness of these technologies in daily clinical practice.
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