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1. Author Dowling RA; Corriere JN Jr; Sandler CM
Title Latrogenic ureteral injury.
Source J Urol 1986 May;135(5): p912-5
ISSN 0022-5347
AbstractWe treated 27 patients with iatrogenic ureteral injuries during a 6-year period. Gynecological operations were the most common antecedent surgical procedures (52 per cent). The diagnosis of ureteral injury was made immediately in 4 patients and was delayed 1 to 34 days in 23. Three of the 4 injuries recognized during an operation were repaired successfully at the time of injury; the primary repair in the remaining patient leaked and ultimately resulted in a nephrectomy. In the delayed diagnosis group retrograde ureteral catheterization was successful in only 1 of 20 attempts. Of the 23 patients with injuries recognized in the postoperative period 11 were managed successfully with percutaneous nephrostomy (with or without stenting) alone, 3 required surgical repair after temporary percutaneous nephrostomy drainage, 4 were treated surgically without prior nephrostomy drainage and 1 had spontaneous resolution of hydronephrosis. The remaining 3 patients required nephrectomy: 1 because of a urinary fistula in a previously irradiated field, 1 because of a concomitant (ipsilateral) renal cell carcinoma and 1 because of renal hypertension. Percutaneous nephrostomy or ureteral stenting was successful as primary therapy in 73 per cent of the patients in whom it was used.
2. Author Neuman M; Eidelman A; Langer R; Golan A; Bukovsky I; Caspi E
Institution Department of Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel.
Title Iatrogenic injuries to the ureter during gynecologic and obstetric operations.
Source Surg Gynecol Obstet 1991 Oct;173(4): p268-72
ISSN 0039-6087
AbstractIatrogenic injuries to the ureter are hazardous complications of pelvic and vaginal operations, causing severe morbidity and even mortality. Eighteen such instances that occurred during the last 30 years are analyzed. Most of the injuries were associated with attempts to achieve hemostasis without proper identification of the ureter. The incidence of ureteral injuries declined during the years concomitantly with the improvement of surgical techniques. The proper identification and, when necessary, isolation of the ureter during operations in which there is a risk is crucial in reducing the incidence of ureteral injuries. Those diagnosed at the time of injury and treated with end to end anastomosis had the best results. Delayed diagnosis and treatment were associated with poor end results. The English literature is reviewed.
3. Author Watterson JD; Mahoney JE; Futter NG; Gaffield J
Institution Department of Urology, Ottawa Hospital, Ont.
Title Iatrogenic ureteric injuries: approaches to etiology and management.
Source Can J Surg 1998 Oct;41(5): p379-82
ISSN 0008-428X
AbstractInjury to the ureter is a risk of any pelvic or abdominal surgery, including laparoscopy and ureteroscopy. The morbidity associated with such injury may be serious, resulting in increased hospital stay, compromise of the original surgical outcome, secondary invasive interventions, reoperation, potential loss of renal function and deterioration of the patient's quality of life. Management of ureteric injuries, in conjunction with frank and open dialogue with the patient, can lead to an optimal outcome. For ureteral ligation, removal of the suture and assessment of ureteral viability are recommended, with surgical correction if necessary. For partial transection primary closure is suggested over stent placement. For uncomplicated upper- and middle-third ureteral injury ureteroureterostomy is the procedure of choice. For injuries above the pelvic brim several procedures are available: ureteroureterostomy, ureteroileal interposition and nephrectomy. For injuries below the pelvic brim ureteroneocystostomy is recommended with a psoas hitch or Boari bladder flap. To decrease the incidence of iatrogenic ureteral injury, a sound knowledge of abdominal and pelvic anatomy is the best prevention. If the proposed operation is likely to be close to the ureter, the ureter should be identified at the pelvic brim. If the dissection is likely to be difficult, preoperative intravenous pyelography and placement of a ureteral catheter may help in identifying and protecting the ureter.
4. Author Gilmour DT
Institution Royal Women's Hospital, Melbourne, Australia. donnagilmour@hotmail.com.
Title Lower urinary tract injury during gynecologic surgery and its detection by intraoperative cystoscopy. [In Process Citation]
Source Obstet Gynecol 1999 Nov;94 Pt 2(5): p883-889
ISSN 0029-7844
AbstractOBJECTIVE: To review the frequency of lower urinary tract injuries after major gynecologic surgery and the role of routine intraoperative cystoscopy during major gynecologic surgery in the detection of lower urinary tract injuries. DATA SOURCES: We combined a MEDLINE search for reports from 1966 to October 1998, using the terms "urinary tract injury," "ureter/ureteric/ureteral obstruction/fistula/injury," "bladder fistula/injury," and "vesico-vaginal fistula," with a second search for all reports of gynecologic surgical procedures. Additional references were obtained from relevant articles and review articles. METHODS OF STUDY SELECTION: Included were all English language articles on the frequency of unintentional urinary tract injuries identified during or after benign gynecologic surgery. There were 22 reports on the frequency of lower urinary tract injuries after gynecologic surgery and eight on the use of routine cystoscopy during gynecologic surgery to diagnose unsuspected injuries. TABULATION, INTEGRATION, AND RESULTS: In the reports of studies not involving routine cystoscopy, the frequency of ureteral injury varied from 0 to 14.6 injuries per 1000 operations, with an overall frequency of 1.6 per 1000. The frequency of bladder injury varied from 0.2 to 19.5 per 1000, with an overall frequency of 2.6 per 1000. Only 11.5% of ureteral injuries and 51.6% of bladder injuries were identified and managed intraoperatively. In the reports of studies involving routine cystoscopy, the frequency of ureteral injury varied from 0 to 26.8 per 1000, with an overall frequency of 6.2 per 1000. The frequency of bladder injury varied from 0 to 29.2 per 1000, with an overall frequency of 10.4 per 1000. Up to 90% of unsuspected ureteral injuries and 85% of unsuspected bladder injuries were identified with the use of cystoscopy and were managed successfully intraoperatively. In 69% of the unsuspected ureteral and bladder injuries, the intraoperative management consisted of removing and replacing sutures or repairing unintentional cystotomies. CONCLUSION: Use of routine intraoperative cystoscopy during major gynecologic and urogynecologic surgery might prevent sequelae from lower urinary tract injuries.
5. Author Wood EC; Maher P; Pelosi MA
Institution Pelosi Women's Medical Center, Bayonne, New Jersey, USA.
Title Routine use of ureteric catheters at laparoscopic hysterectomy may cause unnecessary complications.
Source J Am Assoc Gynecol Laparosc 1996 May;3(3): p393-7
ISSN 1074-3804
AbstractSTUDY OBJECTIVE: To test the use of ureteric catheters in preventing ureteric trauma during laparoscopic hysterectomy. DESIGN: Prospective study of 492 consecutive women. SETTING: Pelosi Women's Medical Center, New Jersey, and Cliveden Hill Private Hospital, Melbourne, Australia. PATIENTS: Four hundred ninety-two consecutive women. INTERVENTIONS: Laparoscopic hysterectomy was performed in all women. Because of the reported increased risk of ureteric trauma during laparoscopic hysterectomy, we passed ureteric catheters in 92 such procedures and ceased the practice with the last 400 when further reports suggested lack of increased risk. MEASUREMENTS AND MAIN RESULTS: Oliguria and anuria occurred in 7 of 92 patients having ureteric catheterization. No ureteric trauma occurred in 400 patients without ureteric catheterization. The injury rate in this series was significantly lower than in three other series of abdominal hysterectomy. CONCLUSIONS: As long as surgical techniques incorporate various procedures to avoid ureteric injury, routine ureteric catheterization during laparoscopic hysterectomy is not indicated and may result in unnecessary complications.
6.Author Chittacharoen A; Theppisai U
Institution Department of Obstetrics & Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Title Urological injury during gynecologic surgical procedures.
Source J Med Assoc Thai 1993 Jan;76 Suppl 1:87-91
ISSN 0125-2208
AbstractUrological injury during gynecologic surgical procedures is an infrequent but serious complication. The incidence from this study is less than other studies. There are 25 cases of urological injuries consisting to twenty-one bladder injuries and four ureteral injuries. The associated factors of the urological injury are previous pelvic operation, distorted anatomy in the pelvis from various diseases and full bladder. Prompt intraoperative recognition of the injury is the best way to prevent serious postoperative complication. Four had vesicovaginal fistulae that were recognized postoperatively. Three had spontaneous closure of fistulae with conservative management and one required surgical management. Patients who had urological injury during the gynecologic surgical procedures had a longer hospital stay. The most important factor in prevention of this injury is a clear exposure of structures at risk.
7. Author Daly JW; Higgins KA
Institution Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, Nebraska.
Title Injury to the ureter during gynecologic surgical procedures.
Source Surg Gynecol Obstet 1988 Jul;167(1): p19-22
ISSN 0039-6087
AbstractThis retrospective study examined ureteral injuries during gynecologic operations from January 1980 to August 1985. The study was conducted at two private hospitals that are involved in resident teaching programs. Each patient was reviewed for predisposing factors, location and type of injury and time and method of recognition. Sixteen injuries were documented in 1,093 extensive procedures. Twelve injuries occurred at the pelvic brim and four others occurred elsewhere in the pelvis. Risk factors included previous surgical procedures in the pelvis, endometriosis, ovarian neoplasm, pelvic adhesions, distorted anatomic features of the pelvis and repair of the bladder. The anatomic structure of the ureter is reviewed, and recommendations are made to help prevent ureteral injury during surgical procedures in the pelvis.
8. Author Daly JW; Higgins KA
Institution Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, Nebraska.
Title Injury to the ureter during gynecologic surgical procedures.
Source Surg Gynecol Obstet 1988 Jul;167(1): p19-22
ISSN 0039-6087
AbstractThis retrospective study examined ureteral injuries during gynecologic operations from January 1980 to August 1985. The study was conducted at two private hospitals that are involved in resident teaching programs. Each patient was reviewed for predisposing factors, location and type of injury and time and method of recognition. Sixteen injuries were documented in 1,093 extensive procedures. Twelve injuries occurred at the pelvic brim and four others occurred elsewhere in the pelvis. Risk factors included previous surgical procedures in the pelvis, endometriosis, ovarian neoplasm, pelvic adhesions, distorted anatomic features of the pelvis and repair of the bladder. The anatomic structure of the ureter is reviewed, and recommendations are made to help prevent ureteral injury during surgical procedures in the pelvis.
9. Author Drake MJ; Noble JG
Institution Churchill Hospital, Headington, Oxford, UK.
Title Ureteric trauma in gynecologic surgery.
Source Int Urogynecol J Pelvic Floor Dysfunct 1998;9(2): p108-17
ISSN 0937-3462
AbstractNearly all gynecological procedures have been reported to cause ureteric injury, with an incidence of 0.4%-2.5% for non-malignant conditions. The incidence is rising as more ambitious operations are undertaken laparoscopically. Risk factors for ureteric injury include cancer, hemorrhage, endometriosis, adhesions and an enlarged uterus. Types of injury include ligation, crush, laceration, avulsion, stretch and devascularization. The diagnosis may be obvious intraoperatively, but postoperative presentation with loin pain, pyrexia, fistula or non-specific signs is more common. A significant number are asymptomatic. Early diagnosis is vital, and urological investigation should be considered in any patient who is not recovering as expected. Injuries recognized intraoperatively should be repaired during the same operation. Delayed recognized injuries are being managed conservatively with increasing success in selected cases. Early operative repair achieves good results unless the injury is severe. Litigation is less likely if the diagnosis is prompt, repair is successful and the patient is treated with consideration.
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11. Author Brudenell M
Title Medico-legal aspects of ureteric damage during abdominal hysterectomy [see comments]
Source Br J Obstet Gynaecol 1996 Dec;103(12): p1180-3
ISSN 0306-5456
12. Author Liu CH; Wang PH; Liu WM; Yuan CC
Institution Department of Obstetrics and Gynecology, Veterans General Hospital-Taipei, 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan.
Title Ureteral injury after laparoscopic surgery.
Source J Am Assoc Gynecol Laparosc 1997 Aug;4(4): p503-6
ISSN 1074-3804
AbstractUreteral injuries are uncommon but serious complications of laparoscopic pelvic surgery. When unrecognized, patients experience fever, abdominal pain, signs of peritonitis, and leukocytosis usually 48 to 72 hours after the surgical procedure. A 48-year-old woman underwent laparoscopic-assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and anterior and posterior colporrhapy due to a large, symptomatic uterine myoma. Postoperatively, she suffered from progressive left lower quadrant pain, with drainage of yellowish fluid from the subumbilical puncture wound 5 days after the operation. Significant urinary ascites was present. Intravenous pyelogram revealed injury to the lower third of the left ureter about 3 cm away from the ureterovesical junction. Left-sided percutaneous nephrostomy was performed after transurethral placement of a ureteral stent failed. Reanastomosis of the ureter was performed successfully 3 months later, and the patient fully recovered without compromise of the genitourinary tract.
13. Author Dowling RA; Corriere JN Jr; Sandler CM
Title Iatrogenic ureteral injury.
Source J Urol 1986 May;135(5): p912-5
ISSN 0022-5347
AbstractWe treated 27 patients with iatrogenic ureteral injuries during a 6-year period. Gynecological operations were the most common antecedent surgical procedures (52 per cent). The diagnosis of ureteral injury was made immediately in 4 patients and was delayed 1 to 34 days in 23. Three of the 4 injuries recognized during an operation were repaired successfully at the time of injury; the primary repair in the remaining patient leaked and ultimately resulted in a nephrectomy. In the delayed diagnosis group retrograde ureteral catheterization was successful in only 1 of 20 attempts. Of the 23 patients with injuries recognized in the postoperative period 11 were managed successfully with percutaneous nephrostomy (with or without stenting) alone, 3 required surgical repair after temporary percutaneous nephrostomy drainage, 4 were treated surgically without prior nephrostomy drainage and 1 had spontaneous resolution of hydronephrosis. The remaining 3 patients required nephrectomy: 1 because of a urinary fistula in a previously irradiated field, 1 because of a concomitant (ipsilateral) renal cell carcinoma and 1 because of renal hypertension. Percutaneous nephrostomy or ureteral stenting was successful as primary therapy in 73 per cent of the patients in whom it was used.
14. Author Boyd ME
Title Care of the ureter in pelvic surgery.
Source Can J Surg 1987 Jul;30(4): p234-6
ISSN 0008-428X
AbstractMaintaining the integrity of the ureter is crucial in pelvic surgery. The ureter is best safeguarded by routine intraoperative exposure, which will also allow immediate recognition of injury to it. If doubts over possible injury persist, it is best to open the bladder. The flux of urine from the ureteric orifices or the retrograde passage of catheters will then confirm or deny clinical suspicions. If specialist help is unavailable, the pelvic surgeon must be able to perform simple ureteric repairs or temporize in a way that allows the safe delay of definitive surgery. End-to-end ureteric anastomosis and ureteroneocystostomy are straight-forward procedures that all pelvic surgeons should be familiar with. If they cannot be performed safely, the situation may be salvaged by draining the proximal ureter through the lateral abdominal wall; later, definitive surgery can be performed.
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