Posthysterectomy ureteric injuries: Presentation and outcome of management

Abstract

Purpose:The purpose of the study was to evaluate the presentation and management of posthysterectomy ureteral injuries.Patients and Methods:Fourteen patients with ureteric injuries after hysterectomy for benign diseases were evaluated. The diagnosis was done based on clinical presentation, intravenous urogram, computed tomography, cystoscopy, and retrograde pyelogram (RGP) depending on the clinical situation.Results:Sixteen iatrogenic ureteric injuries in 14 patients over a 2-year period were evaluated. Hysterectomy was the cause of injury in all the cases, 12 abdominal and 2 were vaginal. Two patients presented with anuria, one had ureteric, and bladder injury with hemoperitoneum underwent emergency laparotomy and bilateral ureteral reimplantation. Another patient underwent RGP followed by stenting on the right side, left side unable to put stent so percutaneous nephrostomy (PCN) was done followed by antegrade stenting later. Two patients presented with septicemia and pyonephrosis were managed initially with PCN followed by balloon dilatation and JJ stenting. RGP and retrograde stenting was done in seven of the remaining ten patients and ureteric reimplantation in three patients.Conclusion:Patient with ureteric injury should be evaluated and intervened at the earliest. Patients presenting early, within 2 weeks after hysterectomy have higher chances of success with endourological procedures, obviating the need for open surgery.

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

“…Minimal access surgery is associated with higher risk of ureteric injury than open surgery [2]. The incidence of ureteric injury varies between 0.5 and 1.5% as a complication of open gynaecologic surgery and 0.5–14% in laparoscopic surgeries in high-income countries with higher prevalence reported among the inexperience surgeons [3]. Surgeons' experience plays a critical role in reported incidence of ureteric injury following laparoscopic gynaecologic surgeries.…”

Post Abdominal Hysterectomy Ureterovaginal Fistula

“…2 The prophylactic use of ureteral stenting during gynecologic surgery is controversial as it does not prevent surgical injury while the routine use of cystoscopy during surgery may help in identiÞ cation of it. 1,3 When identiÞ ed intraoperatively immediate repair is favored to avoid the postoperative morbidity, prolonged hospital stay, and inconvenience of a second operation. 4 In delayed identiÞ cation of ureteric injury, patient may present with ß ank pain, fever or Þ stula.…”

“…Various investigations like methylene blue dye test, USG abdomen, intravenous urography and CT urography can be done to localize the site of injury and to conÞ rm the diagnosis. 1 Treatment for UVF depends on site, size, its etiology, and associated injuries, previously treatment was preferred after 3-6 month of injury to allow healing of injury and Þ stulas to become smaller before attempting a repair. 4 Now early intervention is preferred to minimize morbidity, discomfort, and cost.…”

“…4 Now early intervention is preferred to minimize morbidity, discomfort, and cost. 1 The management of ureterovaginal Þ stula are aimed for the conservation of renal function and restoration of ureteral integrity by ureteroneocystostomy or end to end anastomosis. And in cases of partial ureteric injury DJ stenting can be done and removed after 6-12 weeks.…”

“…Ureteric injury can occur during pelvic and abdominal surgery like gynecologic, urologic, colonic and vascular surgeries. 1 Approximately two third of these injuries occur during gynecological surgery. 2 Incidence of ureterovaginal Þ stula (UVF) occurring due to ureteric injury during gynecological surgery is 0.5-2.5% when surgery is done for benign condition and it increases to 5% for oncologic condition.…”