Our Experience with Iatrogenic Ureteric Injuries among Women Presenting to University College Hospital, Ibadan: A Call to Action on Trigger Factors

Abstract

Background. Ureteric injuries leading to ureterovaginal fistula (UVF) is less common than vesicovaginal fistula, as a cause of urinary incontinence. Recently, there is a surge in the number of UVF cases presenting to University College Hospital (UCH) following a caesarean delivery. The urogynaecology unit at UCH is at the forefront of providing surgical repair for women with all forms of genitourinary fistulas. We describe our experience with managing UVF arising from ureteric injury. Methods. A retrospective data collection of UVF cases managed from January 2012–December 2017 at UCH is presented. Information on sociodemographic and obstetric characteristics, presenting complaints, antecedent surgery, treatment received, findings at surgery, and postoperative complications were obtained with a structured proforma. Results. Eighteen cases of UVFs due to iatrogenic ureteric injury were managed. Majority (N=11; 61.1%) of the women suffered the injury following the emergency caesarean section (EMCS). Abdominal hysterectomy operation accounted for four (22.2%) cases, and one case each (5.6%) was due to vaginal hysterectomy and destructive operations. Prolonged obstructed labour (POL) (81.8%) was the most common indication for the EMCS, while 18.2% had surgery on account of lower uterine segment fibroid. Most of the ureteric injuries were on the left side. Postoperative complications documented were haemorrhage, urinary tract infection, wound infection, and injury to the neighbouring structure. Conclusion. Caesarean section being one of the most performed surgical operations in Nigeria was surprisingly found to be the most common cause of ureteric injury ahead of hysterectomy. It is a pointer that the surgeons might not have properly learnt the art of the caesarean delivery well. We recommend adequate surgical training of medical officers/surgeons that are involved.

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“…The left ureteric injury occurred frequently following surgery, the left ureter bringing it closer to the pelvic structures, the left ureter more to iatrogenic injures. 5 In our study the left ureteric injury occurred frequently 66%. The placement of ureteric stents preoperatively wasn't decreasing the ureteric injuries risk as demonstrated by Kuno et al In fact, the presence of the ureteric stents may actually make the ureter less pliable and more rigid thereby increasing the injury risk during dissection to mobilize it.…”

“…Shoemaker introduced the Ileal ureter replacement and was popularized by Goodwin et al 19 Some studies found high success rate with ureteroneocystostomy. 5 In all injuries of ureteric percutaneous nephrostomy drainage recovered of ureter in 80% cases. 10 Lask et al ureteric injuries patients under percutaneous nephrostomy, out of these 16 (80%) had complete spontaneous recovery of injured ureter after 14-66 days.…”

“…surgery risk factors are pelvic malignancy, huge pelvic masses, congenital anomalies of the urinary system, previous abdominopelvic surgery, and radiation therapy. 5 Difficulty in visualization because of distorted anatomy, excessive hemorrhage at surgery time and rarely congenital abnormalities i.e., duplication of ureter are the usual causes of inadvertent injury. 6 Visualization of the ureter during the procedure is reliable and cost effective.…”

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Iatrogenic Ureteral Injuries Associated with Gynecological and Surgical Procedures: Our Experience About 18 Cases and Literature Review

“…15 In contrast to that reported by Olatunji et al in Nigeria where caesarian delivery was the leading gynecologic surgery, in our study, hysterectomy was reported in 61% Globally, iatrogenic ureteric trauma is the common cause of ureteral injury with gynecologic surgery being the most causative event. 16 According to the laterality, the lesion was unilateral in 95% with the left ureter 72% of cases. In the study of Chalya et al in Tanzania, the left side was also reported in 70% of cases.…”