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Background: The value of tranexamic acid (TA) treatment as bleeding prophylaxis in major uterine surgery is unclear.Objectives: To evaluate the antihemorrhagic effect of prophylactic TA treatment in major benign uterine surgery.Search Strategy: PubMed, Embase, Cochrane Library, and Web of Science were searched from 1980 to 2015 without language restriction using search terms related to major uterine surgery combined with TA.Selection Criteria: Randomized controlled trials comparing prophylactic TA with placebo or no intervention in women undergoing elective major benign uterine surgery.Data Collection and Analysis: Basic information and outcomes were collected and meta-analyses performed.Main Results: Sixteen trials were included, with five trials considered to have an overall low risk of bias. In cesarean delivery, TA significantly reduced intraoperative bleeding (mean -136 mL, 95% confidence interval [CI] -189 to -83), blood loss of more than 1000 mL (relative risk 0.38, 95% CI 0.18-0.81), and blood transfusion (relative risk 0.32, 95% CI 0.17-0.59). In abdominal myomectomy, TA also significantly reduced intraoperative bleeding (mean -251 mL, 95% CI -391 to -110).Conclusions: Prophylactic TA treatment significantly reduced operative bleeding in women undergoing elective cesarean delivery or abdominal myomectomy. Additional randomized trials with low risk of bias are needed. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to present urinary tract injuries occurring during obstetric and gynecological operations and their clinical consequences. Methods: Twenty-three patients had urological organ injury during obstetric and gynecological operations in a tertiary care center between January 2010 and June 2016, were analyzed retrospectively. Etiologies, type of injury, diagnostic process, treatment methods and complications of urologic injuries and success rate have been investigated. Injuries were categorized into two groups as intra-operative early injuries and post-op late injuries. Early injuries were laceration, rupture, ligation and late injuries were hydronephrosis, contrast material leakage or fistula. Results: Eight patients were diagnosed during operation period or post-op early period and 15 patients who were referred from other hospitals. Thirteen of the injuries were gynecologic and 10 of them were obstetric. Mean age of operated patients was 34.2±9.4 (23-65) years. Ureteral injury and bladder injury was detected respectively in six and two patients getting early diagnosis. Fistula (5/15), hydronephrosis secondary to urethral stricture (3/15) and vaginal erosion (3/15) were detected as late diagnosed injuries. In a patient whom ureter was ligated non-functioning kidney has developed. Conclusions: To reduce rate of urinary system injuries a sound knowledge of anatomy is required and corrected surgical techniques should be used. Early diagnosis and therapy may prevent complications and loss of organs that may lead to morbidity. [ABSTRACT FROM AUTHOR]