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 iatrogenic urinary tract injuries; however, comparative data on injury patterns, diagnostic timing, and management across different surgical indications remain limited. This study aimed to evaluate the incidence, characteristics, diagnostic timing, and outcomes of urological injuries following gynecologic and obstetric surgeries in a high-volume tertiary referral center over a 10-year period. Methods: This retrospective single-center cohort study included adult female patients who sustained intraoperative or postoperative urological injuries during gynecologic or obstetric procedures between January 2014 and December 2024. Urological injury was defined as bladder, ureteral, or genitourinary fistula injury requiring urological intervention. Patients with prophylactic or temporary ureteral stenting were excluded. Cases were classified into malignant gynecologic, obstetric, and benign gynecologic surgery groups. Injury type, timing of diagnosis, management strategies, and clinical outcomes were analyzed. Results: Among 16,100 procedures, 223 urological injuries were identified (incidence: 1.3%). Bladder injuries were the most common (62.3%) and were predominantly associated with obstetric procedures, whereas ureteral injuries (28.7%) occurred more frequently during malignant gynecologic surgeries (p < 0.05). Intraoperative recognition rates varied significantly by injury type, being highest for bladder injuries (98.6%) and lowest for fistulas (5.0%) (p < 0.001). Conclusions: Surgical indication significantly influences the pattern and timing of urological injuries. Bladder injuries are usually detected intraoperatively, whereas ureteral and fistulous injuries are more often diagnosed postoperatively, particularly in malignant and complex procedures, highlighting the need for targeted intraoperative vigilance and multidisciplinary management in high-risk cases.