Iatrogenic Ureteral Injuries during Radical Hysterectomy: A Review of 23 Cases

Yoon, Jai Yeung; Hwang, Tae Kon; Park, Hae Cheol

Abstract

We reviewed 23 patients with iatrogenic ureteral injuries due to radical hysterectomy from May 1981 to April 1994. The overall incidence of iatrogenic ureteral injuries was2.2% and the incidences in cervical cancer stage I, IIa, IIb, and III were 1.2, 4.8, 8.4,and 11.1%, respectively. 13 cases(56.5%) were occurred in right side and 10(43.5%) in left side. The diagnosis of ureteral injury was made intraoperatively in 16 cases(69.6%) and postoperatively in 7 cases (30.4%). The ureteral injuries in intraoperative diagnosis group at recognition were complete transection 10 cases, partial transection 4 and ligation 2. The clinical findings of postoperative diagnosis group were ureterocutaneous fistula 4 cases, ureteral obstruction 2 and ureterovaginal fistula 1, and the presenting symptoms were fever 6 cases, urine leakage 5, flank pain 4. The treatments in intraoperative diagnosis group were ureteroureterostomy 7 cases, ureteroneocystostomy 5 and simple closure 4. In postoperative diagnosis group their treatments were initiated soon after establish of, the diagnosis and consisted of ureteroneocystostomy 3 cases, ureteral stenting with ureteroscope 2, ureteroureterostomy 1 and renal autotransplantation 1. The results were good in 10 cases(76.9%) of intraoperative diagnosis group and 4(57.1%) of postoperative diagnosis group. Of the 6 poor resulted cases 3 cases were managed with percutaneous nephrostomy, 2 cases with ureteral stenting and 1 case was expired due to sepsis. In 2 cases of postoperative diagnosis group and 2 poor resulted cases ureteral stenting with ureteroscope was successful. We concluded that the incidence of iatrogenic ureteral injuries was increased according to the cancer stage, and suggest that the ureteral stenting with ureteroscope is a first recommendable method in postoperative diagnosis group and early surgical approach would be better to the injured area whenever possible.