Ureteric Injuries after Hysterectomy in a Tertiary Care Center of Nepal: A Descriptive Cross-sectional Study

Abstract

Introduction: Pelvic surgery is the most common cause of iatrogenic ureteral injury. The incidence of ureteric injuries varies between skilled and inexperienced surgeons. The study aims to determine the prevalence of ureteric injuries sustained during hysterectomy in a tertiary care center of Nepal. Methods: A descriptive cross-sectional study involving the women attending the gynecological outpatient department of a tertiary care center of Nepal, for various benign and malignant conditions and later on underwent hysterectomy from June 2019 to June 2020 was done after obtaining ethical clearence from the Institutional Review Committee (Reference No. 245). Convenient sampling method was used. The data were entered in Excel and analyzed using Statistical Package for Social Sciences version 17. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Altogether, 1 (0.63%) (0.55-0.71 at 95% Confidence Interval) out of 159 patients sustained the ureteric injury during hysterectomy in a tertiary care center of Nepal. The injury was seen during the exploratory laparotomy for adnexal mass. The injury was recognized intraoperatively and was repaired with double J stenting. A total of 159 patients were enrolled in the study that had undergone hysterectomy over one year for various benign and malignant conditions. Out of which 21 (13.2%) had undergone surgeries for malignant conditions and 138 (86.79%) for benign conditions. Conclusions: Iatrogenic ureteric is still a major cause of harm and concern in hysterectomy. Patients with ureteric injury should be evaluated and intervened at the earliest.

"Urological Surgical Injuries in Gynecology and Obstetrics. 10-Year Review"

“…The incidence of bladder injury varies depending on the procedure; Wong et al reported an incidence of 0.24% in laparoscopic surgery in benign pathology; Other studies report an incidence of 0.44% in cesarean sections and 1.54% during hysterectomies for benign pathol-Volume 54-Issue 4 DOI: 10.26717/BJSTR.2024.54.008586 ogy [8,9]. Lower urinary tract injuries including bladder injuries are associated with increased morbidity; This includes the formation of fistulas, infections, hydronephrosis and kidney injury, combined with a 60% percentage of reinterventions, with an increase in hospital stay and affecting quality of life [6,10,11].…”

“…[8,12]. One third of ureter injuries are diagnosed intraopera-tively; The rest of the lesions are diagnosed postoperatively, in which the clinical manifestations include fever, peritonitis, paralytic ileus, urinoma, abscess, hematuria, leakage of urine through the vagina, or through drains [1,10]. Early diagnosis of injuries is a priority because it allows early repair with a better prognosis since it minimizes longterm morbidity [5,9,14].…”

Delayed Diagnosis and Management of Ureteral Injuries after Procedures Following Gynecological Cancers

“…All of the above negatively affects the final outcome of repair procedures, significantly complicating postoperative rehabilitation of patients. The management of UIs established postoperatively, with the subsequent formation of ureteral strictures/obliteration or ureterovaginal fistula, has witnessed constant transformations over the past decade, ranging from the frequently used open approach, to the minimally invasive endourological procedures such as retrograde or antegrade stent insertion, and percutaneous nephrostomy tube placement [12][13][14][15][16]. Coupled with UIs, complications from pelvic surgeries could lead to other lower urinary tract dysfunction, for example, injuries to the pelvic nerves, can cause long-term bladder dysfunction in patients [17,18].…”