Diagnosis of Ureteral Obstruction during Complex Urogynecologic Surgery

Abstract

Intraoperative cystoscopy has been recommended to identify unsuspected bladder and ureteral injuries resulting from gynecologic surgery. We retrospectively reviewed 157 cases of complex urogynecologic procedures at our institution. Intraoperative cystoscopy revealed no bladder injuries. Five cases of unsuspected ureteral obstruction were identified (3.2%). One case of ureteral ligation was diagnosed and repaired intraoperatively. The remaining 4 cases were found to represent chronic ureteral obstruction resulting from pelvic organ prolapse (2 cases), ureteropelvic junction obstruction (1 case) and stenosis of the ureterovesical junction after transurethral resection (1 case). Intraoperative assessment required an average of 90 minutes. Our experience suggests that pre-existing ureteral obstruction may be more common than intraoperative injury. In selected populations, routine preoperative assessment of the ureters is indicated to simplify intraoperative evaluation.

Urinary Tract Injury During Hysterectomy Based on Universal Cystoscopy

“…A retrospective review concluded that preoperative evaluation may be useful in selected cases, but it was also admitted that preoperative measures have not resulted in a reduction in intraoperative injuries. 15 The only risk factor for injury was blood loss greater than 800 mL and increased operating time. Degree of difficulty (determined by the resident performing the case) was not significant, but unexplained is the increased injury rate with increased body mass index and increased uterine size ( Table 2).…”

Management of ureteral injuries associated with vaginal surgery for pelvic organ prolapse

“…The reported incidence of ureteral injuries following procedures such as sacrospinous fixation, vaginal vault suspensions, sacrocolpopexy, urethropexy, and bladder neck suspensions ranges from 2 to 11% [2,3]. Given the proximity of the ureter to the female genital tract, ureteral injuries are a known complication of complex pelvic reconstructive surgery.…”

Association of intraoperative gross hematuria with acute kidney injury after cytoreductive surgery

“…Presently, no gold standard for diagnosing ureter injury is available. Although intraoperative cystoscopy [ 35 ] and postoperative CT [ 31 ] reportedly allow precise diagnosis of unsuspected ureteral injuries, it remains unclear whether these tests are able to detect varying degrees of ureteral obstruction as suggested by Siddighi [ 19 ]. In our hospital, intraoperative cystoscopy, postoperative CT and ultrasonography were not routinely performed in CRS-HIPEC, and this might also be the case in other hospitals.…”