Korean J Urol.  2012 Feb;53(2):120-125.

Ureteral Injury in Gynecologic Surgery: A 5-Year Review in A Community Hospital

• Park JH
• Park JW
• Song K
• Jo MK

Abstract

PURPOSE
We reviewed the cases of ureteral injury during gynecologic surgeries in a community hospital and attempted to find possible options for alleviating these distressing situations.
MATERIALS AND METHODS
A total of 2,927 patients underwent gynecologic surgeries in the last 5 years at our hospital. We retrospectively analyzed the cases, particularly the possible risk factors and management according to the time of detection of the injury. Thirty-five cases (1.2%) were identified with ureteral injury in a total of 2,927 gynecologic surgeries. Risk factors included endometriosis, pelvic inflammatory disease, previous pelvic surgery, history of pelvic radiation, and congenital anomalies. Among 2,927 patients, 522 had predisposing factors for ureteral injuries.
RESULTS
The incidence of ureteral injury in laparoscopic cases was 1.1%, similar to the cases of laparotomy (1.2%). The rate of ureteral injury was significantly higher in the group with risk factors (2.7%) than in the group without risk factors (0.9%; p=0.002). Prophylactic ureteral stenting was performed in 101 of 522 patients with risk factors according to the gynecologic surgeon's preference. The injury rate (1.0%) in the stenting group was lower than that in the non-stenting group (3.1%; p=0.324). Management of ureteral injuries was successful in all cases. Of the patients with postoperatively diagnosed injuries, two patients were managed with secondary procedures, such as retrograde balloon dilatation or ureteroneocystostomy.
CONCLUSIONS
The incidence of ureteral injury was significantly higher in cases having risk factors than in cases without risk factors. Surgeons should be cautious to avoid ureteral injury during gynecologic surgery, especially in patients with risk factors.

Keyword

Gynecologic surgical procedures; Laparotomy; Stents; Ureter; Wounds and injuries

MeSH Terms

Dilatation
Endometriosis
Female
Gynecologic Surgical Procedures
Hospitals, Community
Humans
Incidence
Laparotomy
Pelvic Inflammatory Disease
Retrospective Studies
Risk Factors
Stents
Ureter

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