Urinary Tract Injuries in Low-Resource Settings

Urinary tract injuries are encountered in high-resource settings as well as in low-resource settings but comparative incidence data are lacking. Particular for low resource countries is the difficult situation under which the causative intervention was performed. Table 1 enumerates some general factors that can influence the risk of surgery. All of these factors may be present at the same time in the same place. Bleeding complications and postoperative infections are frequent. Conditions like HIV, tuberculosis and female genital schistosomiasis may intervene. A high prevalence of cervical cancer must be remembered. Factors relevant for the hysterectomy procedure in particular are: General anesthesia with muscle relaxation is seldom available; operations must be done in spinal anesthesia normally. Suitable instruments and equipment like suction and diathermia are often lacking. Minimal invasive procedures (laparoscopy, endoscopy) are seldom available.