Iatrogenic ureteral injury after gynecological surgery (original) (raw)
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Ureteric Injury in Gynecology Surgery
Urinary Tract Infection and Nephropathy - Insights into Potential Relationship [Working Title], 2021
It is the most serious and trouble-some complication of pelvic surgery and common reason for medico-legal action by the patient. It can be unilateral or bilateral. Lowest 3 cm of ureter is usually injured. 75% of injuries result from gynecological operations - 3/4th during abdominal and 1/4th during vaginal operations. As most injuries can be diagnosed intraoperatively, systematic assessment of urinary tract integrity should be part of the surgical plan. Intraoperative cystoscopy using either flexible or rigid instruments can aid in the diagnosis or exclusion of urinary tract injury. Identification of the mechanism of injury and its location guides immediate or delayed repair. Mobilization should be sufficient to allow a tension-free closure. Tissue interposition is typically recommended. Common sites for ureteral injury are found beneath the uterine vessels near the cardinal ligament and beneath the infundibulopelvic ligament and the tunnel of Wertheim. Successful ureteral repair r...
Journal of Gynecologic Surgery, 2003
Damage to the lower ureters during pelvic surgery is a serious and well-recognized complication. In most series, ureteric injury occurred in 0.5%-1.0% of all pelvic operations. The incidence of ureteric injuries is high with extensive abdominal operations for carcinoma of cervix (1.5%-2.5%) more so with patients who had preoperative radiotherapy. We treated 34 women with iatrogenic ureteric injuries during a 20-year period following radical hysterectomy for carcinoma cervix. The time of recognition of injury in 25 cases was during primary surgery and treated immediately. Surgery was uneventful in 9 patients of whom 7 presented in the early postoperative period and 2 during follow-up. These patients were managed by ureteroneocystostomy, percutaneous nephrostomy (PCN), and double J (DJ) stenting. All the renal units were salvaged. Immediate ureteric repair is advocated for all injuries discovered intraoperatively. Action to prevent the development of iatrogenic ureteral injury must be taken in advance, and the management of ureteric injuries could be improved with prompt recognition and repair by a skilled surgeon. Unrecognized injuries cause prolonged morbidity, and their management can be difficult. (J GYNECOL SURG 19:133
Management of ureteral injuries associated with vaginal surgery for pelvic organ prolapse
International Urogynecology Journal, 2006
Due to the anatomic proximity of the urinary and genital tracts, iatrogenic ureteral injury during pelvic organ prolapse repairs is a serious complication that we have managed in increasing number at our institution. However, few centers have reported on their experience with ureteric injuries associated with gynecologic reconstructive surgery. These ureteral injuries may lead to much morbidity, in particular the formation of ureterovaginal fistula, and the potential loss of renal function especially when diagnosed postoperatively. It is necessary, therefore, for surgeons to have a thorough knowledge of ureteral anatomy and to take precautions to prevent such injuries. The purpose of this article is to review this pertinent anatomy and the key principles of management of ureteric complications of transvaginal surgery for pelvic organ prolapse. The present study illustrates the application of our treatment algorithm based on the time of presentation and the patient condition.
Ureteric injuries associated with gynecologic surgery
International Journal of Gynecology & Obstetrics, 1991
injuries of the urinary tract, ureteric injuries are the most difficult to recognize, although they produce the most serious complications. Because scanty information regarding this subject exists in the authors' environment, we have reviewed all cases of ureteric injuries associated with gynecological operations in a Nigerian university teaching hospital over an 11-year period in order to determine the nature and significance of this problem.
Management of ureteric injuries during gynecological operations: 10 years experience
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2002
Objective(s): To present our 10 years experience in the management of ureteric injuries occurring during gynecological surgery. Study design: Seventy-six patients had a variety of injuries. In 29 cases, the ureteric damage was diagnosed intraoperatively. Management of early-diagnosed injuries included suturing, ligature removal, end-to-end anastomosis, and reimplantation of the ureter. In 47 cases, the injury was diagnosed postoperatively. Ureteric catheterization was attempted in all cases presenting with obstruction. Catheterization failures were managed with ureterolysis, and reimplantation. Small ureteric fistula were managed with catheterization, and large communications with reimplantation. Two cases with urinomas were treated with surgical evacuation and anastomoses. Results: Management of early-diagnosed injuries was relatively easy in most cases. Postoperatively-diagnosed injuries were more difficult to treat. Catheterization failed in 28/44 (65.9%) ureters and surgical re-exploration was necessary. Long-term morbidity was minimal and no relapses occurred. Conclusion(s): Early recognition of a ureteric injury is the key to a complications-free repair. Unrecognized injuries cause prolonged morbidity, and their management can be difficult. Treatment of these injuries by experienced teams may minimize longterm consequences. #
Research and Reports in Urology, 2021
Aim To describe the epidemiological aspects, etiology and outcome of iatrogenic ureteral injury repair at the urology division of Souro Teaching Hospital of Bobo Dioulasso (Burkina-Faso). Patients and Methods This was a retrospective descriptive study of consecutive patients with iatrogenic ureteric injuries who were referred and managed in the urology division of Souro Sanou Teaching Hospital (Bobo-Dioulasso) from January 2012 to December 2017. Variables studied were age, the time at the diagnosis, the causative event, the method of repair, and the outcome of the management. Results The mean age was 37.72±3.5 years coming from the rural population in most cases. The mean time at the diagnosis was 15 days. The injuries were due to gynecologic surgeries with hysterectomy (66%) and caesarian section (33%). Ureteric reimplantation with anti-reflux system was performed in seventeen patients. The rate of treatment success was 94% and the postoperative course was uneventful for all the pa...
Although iatrogenic ureteral injuries are uncommon, but continues to poses a great challenge of potencial injuries to the gyanaecologists and young surgeons, especially during difficult abdominal and pelvic surgeries. We present two cases of ureteral injuries in our centre which occurred during challenging gynaecolgical procedures. Extensive abdomino-pelvic adhesions and large pelvic tumours were the main risk factors in the two index cases . Sites of injuries and the risk factors were discussed. Thorough preoperative evaluation in anticipation of iatrogenic injuries, sound knowledge of surgical anatomy with experience, ureteral stenting before the main procedure, meticulous dissections and discouraging "blind clamping" during bloody procedures among others can prevent such injuries. High index of suspicion is important for early detection of the injuries.
IOSR Journal of Dental and Medical Sciences, 2014
Although iatrogenic ureteral injuries are uncommon, but continues to poses a great challenge of potencial injuries to the gyanaecologists and young surgeons, especially during difficult abdominal and pelvic surgeries. We present two cases of ureteral injuries in our centre which occurred during challenging gynaecolgical procedures. Extensive abdomino-pelvic adhesions and large pelvic tumours were the main risk factors in the two index cases. Sites of injuries and the risk factors were discussed. Thorough preoperative evaluation in anticipation of iatrogenic injuries, sound knowledge of surgical anatomy with experience, ureteral stenting before the main procedure, meticulous dissections and discouraging "blind clamping" during bloody procedures among others can prevent such injuries. High index of suspicion is important for early detection of the injuries.
The Management of Bilateral Ureteric Injury following Radical Hysterectomy
Advances in Urology, 2008
Iatrogenic ureteric injury is a well-recognised complication of radical hysterectomy. Bilateral ureteric injuries are rare, but do pose a considerable reconstructive challenge. We searched a prospectively acquired departmental database of ureteric injuries to identify patients with bilateral ureteric injury following radical hysterectomy. Five patients suffered bilateral ureteric injury over a 6-year period. Initial placement of ureteric stents was attempted in all patients. Stents were placed retrogradely into 6 ureters and antegradely into 2 ureters. In 1 patient ureteric stents could not be placed and they underwent primary ureteric reimplantation. In the 4 patients in which stents were placed, 2 were managed with stents alone, 1 required ureteric reimplantation for a persistent ureterovaginal fistula, and 1 developed a recurrent stricture. No patient managed by ureteric stenting suffered deterioration in serum creatinine. We feel that ureteric stenting, when possible, offers a s...
Diagnosis and management of iatrogenic ureteral injury in total laparoscopic hysterectomy
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Ureteral injury is common in gynecological surgeries due to the proximity to organs. The risk of ureteral injury is higher in laparoscopic hysterectomy operations compared to abdominal or vaginal hysterectomies. Obesity, endometriosis, pelvic adhesions, history of previous surgery, enlarged uterus, and intraoperative hemorrhage are some of the risk factors identified for ureteral injury. Intraoperative cystoscopy and postoperative urinary ultrasonography can be used in the diagnosis of early ureteral injury. Management of ureteral injury differs according to the extent, type, and localization of the injury. In evaluating the ureteral injury, early diagnosis and early repair in appropriate patients are essential in morbidity and medicolegal.