Management of Iatrogenic Ureteral Injuries with Delayed Diagnosis

Ku, Ja Hyeon; Kim, Min Eui; Park, Young Ho

Abstract

PURPOSE: We intended to compare with the effectiveness of conservative and immediate surgical management of iatrogenic ureteral injuries according to the types of injury.
MATERIALS AND METHODS
We reviewed the medical records of 32 cases with iatrogenic ureteral injuries resulting from obstetric and gynecologic procedures from June 1986 to October 1997. The age of these patients ranged from 24 to 76 years(mean age 50.7).
RESULTS
The types of procedure resulting in iatrogenic ureteral injuries were radical hysterectomy in 16 cases(50.0%), abdominal hysterectomy in 8 cases(25.0%), cesarean section in 5 cases(15.6%), salpingoophorectomy in 1 case(3.1%) and radiation therapy in 2 cases(6.3%). The types of urethral injury were urethral obstruction in 18 cases(56.3%), ureterovaginal fistula in 9 cases(28.1%) and ureterocutaneous fistula in 5 cases(15.6%). As the initial treatment, conservative treatments were in 17 cases(56.7%) and surgical treatments were in 13 cases(43.3%). The result of surgical treatment as the initial treatment was good in all cases, but the failure rate of conservative treatment was 35.2%.
CONCLUSIONS
Generally conservative treatment is the first recommendable method in iatrogenic urethral injuries with delayed diagnosis, but early definitive operative repair may be more feasible and preferable method in selected cases regardless of types of urethral injury.