Non Urological Iatrogenic Ureteric Injuries: Management and Outcome

Muhammad Mansoor

Abstract

Objective 

To analyze presentation and outcome of the management of iatrogenic ureteric injuries caused by different non-urological procedures.

Study design 

Descriptive case series.

Place & Duration of study

Department of Urology, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from January 2013 to December 2019.

Methodology

All cases of ureteric injuries referred to urology section from other departments of the hospital were included. All pertinent details for diagnosis, operative procedures and postoperative complications were recorded. A regular follow up was done of all patients. Descriptive statistics were used to present data.

Results 

A total of 48 iatrogenic ureteric injuries in 45 patients were managed during the study period. Mean age of the patients was 34.55±8.74 year. There were 40 females (88.9%) and 05 males (11.1%). Out of the total ureteric injuries, 28 (58.3%) were on left side, 20 (41.7%) on right side inclusive of three bilateral trauma. Distal ureteric injuries were most commonly encountered (n=43 - 89.5%), followed by mid-ureteric (n=3 - 6.2%) and 2 (4.2%) in proximal ureter.

Gynecological and obstetrical procedures resulted in most of the injuries (n=36 - 80.0%), followed by general surgical procedures (n=9 - 20.0%). Abdominal hysterectomy was the most common gynecological procedure where ureter was injured while laparoscopic colectomy was the most common general surgical procedure resulting in similar trauma. Majority (71.1%) of the patients were diagnosed in early postoperative period. Percutaneous nephrostomy was the most common (44.31%) palliative operative procedure performed. Uretero-neocystostomy was the most common definitive operative procedure performed in 22 (48.8%) patients. Nephrectomy was necessary in 8.8% of patients. The success rate was 91.1%.

Conclusion

Total abdominal hysterectomy was the most common surgical procedure resulting in ureteric injury. During the operation good surgical technique with identification of course of the ureter is important step to decrease the risk of injury.

Key words

Iatrogenic, Non-urological, Ureteric injuries, Abdominal hysterectomy.