Our Experience with Iatrogenic Ureteric Injuries Following Obstetric and Gynaecological Surgery at a Tertiary Care Center
DOI:
https://doi.org/10.51253/pafmj.v74i2.6142Keywords:
Cesarean Section, Flank Pain, Gynecologic Surgical Procedures, Hysterectomy, Iatrogenic Disease, Oliguria, Ureter, Urinary IncontinenceAbstract
Objective: To study the pattern of presentation, diagnosis and management outcome of ureteric injury sustained during obstetric and gynaecological surgery.
Study Design: Case series.
Place and Duration of Study: Armed Forces Institute of Urology Combined Military Hospital, Lahore Pakistan, from Nov 2010 to Nov 2020.
Methodology: Eighty-three patients satisfying inclusion criteria (suspected ureteric injury after gynaecological/obstetric intervention) were included. Demographic details, primary surgeon, presenting features, diagnostic workup, treatment instituted, complications, and success were recorded and analyzed.
Results: The study analyzed 83 patients with a mean age of 44.6±10.8 years and a mean parity of 3.4±1.4 children. The ovarian tumour was the most common cause of primary surgery (32, 38.6%), and the majority (64,77.1%) involved less experienced gynaecologists. Flank/abdominal pain was the main presentation (56, 67.5%), followed by oliguria. The left ureter was affected in the majority (58, 69.9%). Ureteric re-implant (37, 44.5%) and JJ stenting (33, 39.8%) constituted major urological interventions. Only three patients (3.6%) had surgical failure; two of them died, while one had redo surgery.
Conclusion: Iatrogenic ureteric injury mostly follows radical gynaecological procedures and must be suspected in case of pain in the abdomen or vague constitutional symptoms after pelvic surgery. Management is dictated by location, time interval, diagnosis, and available surgical expertise.
Downloads
Metrics
References
Jacob GB, Vilos GA, AlTurki F, BhanGaV G, Abu-raFea B, Vilos
AG, et al. Ureteric Injury During Gynecological Surgery –
Lessons from 20 Cases in Canada. Facts Views Vis Obgyn 2020,
(1): 31-42
Naicker S, Naidoo TD, Moodley J. Obstetric-associated lower
urinary tract injuries: A case series from a tertiary centre in a
low-resource setting. Case Rep Women Health 2020; 27(2):
e00218. https://doi.org/10.1016/j.crwh.2020.e00218.
Sebukoto HR, Semwaga E, Rugakingila RA. Urological injuries
following obstetrical and gynecological surgeries. East Cent Afr J
surg 2016; 21(1): 148-155.
https://doi.org/10.4314/ecajs.v21i1.139046.
Ficarra V, Rossanese M, Crestani A, Caloggero S, Alario G,
Novara G, et al. A contemporary case series of complex surgical
repair of surgical/endoscopic injuries to the abdominal ureter.
Eur Urol Focus 2020; 16: S2405-4569(20)30209-1.
https://doi.org/10.1016/j.euf.2020.07.003.
Bello OO, Morhason-Bello IO, Ojengbede OA. Nigeria, a high
burden state of obstetric fistula: a contextual analysis of key
drivers. Pan Afr Med J 2020; 36(1): 22.
https://doi.org/10.11604/pamj.2020.36.22.22204.
Manoucheri E, Cohen SL, Sandberg EM, Kibel AS, Einarsson J.
Ureteral injury in laparoscopic gynecologic surgery. Rev Obstet
Gynecol 2012; 5(2): 106-111.
Wong JMK, Bortoletto P, Tolentino J, Jung MJ, Milad MP.
Urinary tract injury in gynecologic laparoscopy for benign
indication: A Systematic Review. Obstet Gynecol 2018;131(1):100-
https://doi.org/10.1097/AOG.0000000000002414.
Burks FN, Santucci RA. Management of iatrogenic ureteral
injury. Ther Adv Urol. 2014; 6(3): 115–124.
https://doi.org/10.1177/1756287214526767.
Higgins CC. Ureteral Injuries During Surgery: A Review of 87
Cases. JAMA 1967; 199(2): 82–88.
https://doi.org/10.1001/jama.1967.03120020076013.
Li X, Wang P, Liu Y, Liu C. Minimally invasive surgical
treatment on delayed uretero-vaginal fistula. BMC Urol 2018;
(1): 96. https://doi.org/10.1186/s12894-018-0410-z.
Gupta R, Mahajan A, Mahajan M, Anand A, Masood S.
management of genitourinary fistulas following benign
gynecological and obstetric procedures: a single surgeon
experience. J Midlife Health 2020; 11(3): 156-160.
https://doi.org/10.4103/jmh.JMH_70_20.
Durrani SN, ur Rehman A, Ullah H, Khan MK, Ullah A. Ureteral
trauma during open surgery: aetiology, presentation and
management. J Ayub Med Coll Abbottabad 2013; 25(3-4): 86-89.
Nawaz FH, Khan ZE, Rizvi J. Urinary tract injuries during
obstetrics and gynaecological surgical procedures at the Aga
Khan University Hospital Karachi, Pakistan: a 20-year review.
Urologia Internationalis 2007; 78(2): 106-111.
https://doi.org/10.1159/000098065.
Matani YS, Bani-Hani KE, Bani-Hani IH. Ureteric injuries during
obstetric and gynecologic procedures. Saudi Med J 2003; 24(4):
-368.
Raassen TJIP, Ngongo CJ, Mahendeka MM. Diagnosis and
management of 365 ureteric injuries following obstetric and
gynecologic surgery in resource-limited settings. Int Urogynecol
J 2018; 29(9): 1303–1309.
https://doi.org/10.1007/s00192-017-3483-4.
Patil SB, Guru N, Kundargi VS, Patil BS, Patil N, Ranka K, et al.
Post hysterectomy ureteric injuries: Presentation and outcome of
management. Urol Ann 2017; 9(1): 4-8.
https://doi.org/10.4103/0974-7796.198838.
Lawal O, Bello O, Morhason-Bello I, Abdus-Salam R, Ojengbede
O. Our Experience with Iatrogenic Ureteric Injuries among
Women Presenting to University College Hospital, Ibadan: A
Call to Action on Trigger Factors. Obstet Gynecol Int 2019;
(2019): 6456141. https://doi.org/10.1155/2019/6456141.
Wanjala A, Mwangi H, Mabeya H. Pattern of ureteric pathology
presenting to a fistula centre in Western Kenya. Adv Urol 2018;
: 5056049. https://doi.org/10.1155/2018/5056049.
Chalya PL, Massinde AN, Kihunrwa A,. Iatrogenic ureteric
injuries following abdomino-pelvic operations: a 10-year tertiary
care hospital experience in Tanzania. World J Emerg Surg 2015;
(10): 17. https://doi.org/10.1186/s13017-015-0011-z.
Matsumura Y, Iemura Y, Fukui S, Kagebayashi Y, Samma S.
Iatrogenic Injuries of Urinary Tract : Outcomes of Surgical
Repairs. Hinyokika Kiyo 2018; 64(3): 95-99.
Downloads
Published
How to Cite
Issue
Section
