Management of Urinary Tract Injuries Following Total Hysterectomy

Abstract

Objective: This study elaborated on the clinical experience of patients who underwent urologic management due to urologic complications after receiving a total hysterectomy at a regional hospital. Materials and methods: A total of 696 female patients received the four types of total hysterectomy including total abdominal hysterectomy, transvaginal hysterectomy, lapaparoscopic hysterectomy or robotic hysterectomy for variant gynecologic pathologies. Only 22 cases (3.2%) had urologic procedures performed during or after the operations from 2012/1/1 to 2016/6/30. Results: Of the 22 cases, thirteen (1.9%) received a series of conservative managements only, including cystoscopy, ureteroscopy, endoscopic ureterotomy, ureteral catheterization or double J stenting during the follow-up period. Nine more complicated cases (1.3%) eventually had definitive management, including repair of the urinary bladder rupture, repair of the vesicovaginal fistula, ureteroureterostomy or ureteroneocystostomy. However, five of these nine cases had both conservative and definitive management. The mean delay interval between the initial management and gynecologic procedure was 19.3 days. For definitive management and the gynecologic procedure, the period was 52.8 days. Conclusions: Compared to previous studies, the incidence of urologic injuries following a total hysterectomy in our hospital was similar. From the paper review, it seems early recognition does not improve the outcome but we found a 100% good outcome in patients with definitive management. Copyright © 2017, Taiwan Urological Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Urological injuries following gynecologic surgery: clinical manifestations, diagnosis and management

“…Repair approaches vary based on the location of the injury [Table 2]; lesions in the upper or middle third of the ureter are primarily repaired with uretero-ureterostomy, in which the distal and proximal ureteral ends are debrided to viable tissue and reconnected with a standard running or interrupted end-to-end anastomosis. Transuretero-ureterostomy serves as a second-line technique, particularly when primary reconstruction is not attainable 61 . Reportedly, transureteroureterostomy features a high potency rate; however its application is mostly limited to patients with unfavorable prognosis, given the concerning risk of injury to the contralateral healthy excretory axis 62 .…”

2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery

“…Transureteroureterostomy represents a second-line technique. It is mostly used when the primary reconstruction is not feasible [ 149 ]. It consists on the mobilization of the “donor ureter” and its transposition below the sigmoid colon through the mesentery, to the “recipient “ureter in order to perform an end-to-side anastomosis [ 150 ].…”

“…The “recipient ureter” should be mobilized as less as possible to avoid disrupting the blood supply to the anastomosis. The “donor ureter” should be stented, and the anastomosis retroperitonealized [ 149 ]. While the reported patency rates are high, transureteroureterostomy has a limited role in ureteral reconstruction being mostly restricted to patients with poor prognosis; the main concern is of injury to the contralateral, healthy excretory axis [ 151 ].…”