Iatrogenic Ureteral Injuries in Pelvic Surgery: A Review of 12 Cases

Yea, Suck Ho; Park, Yong Il

Abstract

We reviewed 12 patients with iatrogenic urethral injuries in pelvic surgery from May 1993 to May 1996. The patients ranged in age from 27 to 52 years (mean age 47). The diagnosis of urethral injury was made intraoperatively in 8 (66.7%) and postoperatively in 4 cases (33.3%). The ureteral injury patterns in intraoperative diagnosis group at recognition were classified into complete transsection in 5, partial transsection in 2 and ligation in 1 case. The clinical findings of postoperative diagnosis group were ureterocutaneous fistula in 1, ureteral obstruction in 2, and ureterovaginal fistula in 1 case. Presenting symptoms were fever in 1, urine leakage in 2, and flank pain in 1 case. The treatments in intraoperative diagnosis group included ureteroureterostomy in 4, ureteroneocystostomy in 2, and simple closure in 2 closes. In postopeative diagnosis group the treatments were initiated soon after establishment of the diagnosis, and consisted of ureteroneocystostomy with psoas hitch in 2, ureteral stunting with ureteroscope in 1, and ureteroureterostomy in 1 case. The RESULTS were good in 7 cases (87.5%) of intraoperative diagnosis group and 2 cases (50.0%) of postopertive diagnosis group. Of the 3 poor resulted cases 2 were managed with percutaneous nephrostomy, and 1 with ureteral stenting. We concluded that prompt recognition of ureteral injuries at occurrence with immediate repair RESULTS in few complications. Injuries detected postoperatively required more complicated procedures to repair the ureter. Because most of the ureteral injuries occurs by the non-urologic surgeon, especially gynecologist or general surgeon, it is important to let them know the fact that immediate repair of the ureter is important and cooperative relationships between urologist and non-urologist are also important during pelvic surgery.