Urological Injuries Following Gynecologic and Obstetric Surgery: Incidence, Diagnosis, and Outcomes From a 10-Year Retrospective Cohort

Background/Objectives: Gynecological and obstetric surgeries carry a risk of urinary tract injuries, which remain important causes of surgical morbidity. This study aimed to evaluate the incidence, etiological factors, diagnostic timing, and management outcomes of urological injuries occurring during these procedures over a 10-year period in a high-volume single-center cohort. Methods: This single-center retrospective study reviewed urinary tract injuries that occurred during gynecologic and obstetric procedures performed between January 2014 and December 2024. Among 16,100 surgeries, 223 cases were identified and analyzed regarding injury incidence, etiology, type, diagnostic timing, and management strategies. Results: Bladder injuries constituted 62.3% of cases, ureteral injuries 28.7%, and genitourinary fistulas 9.0%. Most bladder injuries (98.6%) and the majority of ureteral injuries (68.8%) were recognized intraoperatively (p < 0.001). Bladder injuries were most frequently associated with cesarean section, whereas ureteral injuries were more common in malignant gynecologic surgeries (p < 0.05). Conclusions: Early recognition and timely intervention remain critical to reducing morbidity associated with iatrogenic urinary tract injuries. These findings underscore the importance of anatomical knowledge, meticulous surgical technique, and appropriate diagnostic evaluation to optimize perioperative outcomes in gynecologic and obstetric surgery.