Ureteral Injury in Gynecologic Surgery: A 5-Year Review in A Community Hospital

Abstract

PurposeWe reviewed the cases of ureteral injury during gynecologic surgeries in a community hospital and attempted to find possible options for alleviating these distressing situations.Materials and MethodsA total of 2,927 patients underwent gynecologic surgeries in the last 5 years at our hospital. We retrospectively analyzed the cases, particularly the possible risk factors and management according to the time of detection of the injury. Thirty-five cases (1.2%) were identified with ureteral injury in a total of 2,927 gynecologic surgeries. Risk factors included endometriosis, pelvic inflammatory disease, previous pelvic surgery, history of pelvic radiation, and congenital anomalies. Among 2,927 patients, 522 had predisposing factors for ureteral injuries.ResultsThe incidence of ureteral injury in laparoscopic cases was 1.1%, similar to the cases of laparotomy (1.2%). The rate of ureteral injury was significantly higher in the group with risk factors (2.7%) than in the group without risk factors (0.9%; p=0.002). Prophylactic ureteral stenting was performed in 101 of 522 patients with risk factors according to the gynecologic surgeon's preference. The injury rate (1.0%) in the stenting group was lower than that in the non-stenting group (3.1%; p=0.324). Management of ureteral injuries was successful in all cases. Of the patients with postoperatively diagnosed injuries, two patients were managed with secondary procedures, such as retrograde balloon dilatation or ureteroneocystostomy.ConclusionsThe incidence of ureteral injury was significantly higher in cases having risk factors than in cases without risk factors. Surgeons should be cautious to avoid ureteral injury during gynecologic surgery, especially in patients with risk factors.

Iatrogenic ureteric injuries in open abdominopelvic surgery: a five year experience in Maiduguri, North Eastern Nigeria

“…[8][9][10] The current study found distal ureter was the commonest site affected, suture ligation is the commonest injury and unilateral injuries were commoner, similar to study by Chalya et al in Tanzania.…”

Laparoscopic Extravesical Lich-Gregoir Ureteroneocystostomy with Psoas Hitch for the Management of Ureterovaginal Fistula in Post-Hysterectomy Patients

“…Léonard et al [10] reported ureteral injury rate 0.3% in laparoscopic hysterectomies comparable to published open hysterectomy series. The rate of ureteral injury was significantly higher in the group with risk factors like endometriosis, pelvic inflammatory disease, previous pelvic surgery, history of pelvic radiation, and congenital anomalies [11]. Sites of ureteral injuries are at the infundibulopelvic ligament, at the level of the uterine artery near the uterosacral ligaments, and within the cardinal ligament at the ureterovesical junction in 80 and 90% cases following gynaecological surgeries [2].…”

Laparoscopic Fluorescent Visualization of the Ureter With Intravenous IRDye800CW

“…Studies have reported an incidence of 0.1 – 7.6% for colorectal and gynecologic surgery with more than 80% going unrecognized intraoperatively. 2,12,13 The Cochrane Review found patients almost 2.5 (OR 2.41, 95% CI 1.21–4.82) times more likely to have a ureteral or bladder injury during a laparoscopic hysterectomy. 10 Decreased tactile sensation, two-dimensional imaging, and patient-specific factors disrupting the normal anatomy all contribute to the increased incidence observed with a laparoscopic approach.…”