The Management of Bilateral Ureteric Injury following Radical Hysterectomy

Abstract

Iatrogenic ureteric injury is a well-recognised complication of radical hysterectomy. Bilateral ureteric injuries are rare, but do pose a considerable reconstructive challenge. We searched a prospectively acquired departmental database of ureteric injuries to identify patients with bilateral ureteric injury following radical hysterectomy. Five patients suffered bilateral ureteric injury over a 6-year period. Initial placement of ureteric stents was attempted in all patients. Stents were placed retrogradely into 6 ureters and antegradely into 2 ureters. In 1 patient ureteric stents could not be placed and they underwent primary ureteric reimplantation. In the 4 patients in which stents were placed, 2 were managed with stents alone, 1 required ureteric reimplantation for a persistent ureterovaginal fistula, and 1 developed a recurrent stricture. No patient managed by ureteric stenting suffered deterioration in serum creatinine. We feel that ureteric stenting, when possible, offers a safe primary management of bilateral ureteric injury at radical hysterectomy.

Suspected iatrogenic ureteric injury: An approach to diagnostic imaging

“…Published rates of IUI in radical hysterectomy range from 5e30% and from 0.5e1.5% in routine gynaecological surgery. 5,6 Indeed, the incidence has risen with the advent of laparoscopic procedures of all types, possibly due to the reduced visual field and lack of tactile feedback. 4 Reported rates of ureteric injury vary significantly according to the type of gynaecological procedure d a review of published studies found that the procedures most associated with IUI are abdominal hysterectomy, radical hysterectomy, ureteric mobilization, peritonealization of the pelvic floor, and attempts to control profuse pelvic bleeding.…”

Salvage repair of rare iatrogenic bilateral ureteral injury after hysterectomy

“…Although open repair is hindered by the issue of performing bilateral bladder reconfiguration by psoas hitch or Boari flap, we managed to overcome this by mobilizing the left ureter and delivering it through the sigmoid colon mesentery to the other side, allowing separate implantation of both injured ureters into the same bladder flap. A similar technique to what was described in our surgical procedure was utilized successfully by Shaw et al [14] It is conceivable that if necessary, a unilateral Boari flap reimplantation with crossing of one of the ureters is also possible if the ureteric injury levels were higher.…”

Combined End-Side Separate Channel Ureteroneocystostomy with Boari Flap to Treat Bilateral Long-Segment Ureteral Defects

“…5-30% of women undergoing radical hysterectomy suffer ureteral injury. 5 Despite improving surgical technique and awareness, it is likely to be a problem.…”