Ureteric injuries during obstetric and gynecologic procedures

OBJECTIVE: To review the ureteric injuries resulting from obstetric and gynecologic procedures with a comparative analysis of current pertinent literature.

METHODS: From January 1994 - December 1997, the medical records of all patients who sustained ureteric injuries as a result of obstetric or gynecologic procedures and managed at the Princess Basma Teaching Hospital, North of Jordan were reviewed. The clinical presentations, investigations, features of injury and treatment modalities were studied.

RESULTS: There were 17 patients with 19 ureteric injuries incurred during obstetric or gynecologic procedures during the study period. Patients were relatively young and presented with loin pain. The left lower ureter was injured in 11 cases. Hysterectomy, alone, accounted for 13 injuries mainly in association with malignancy. Deliveries, in general, were associated with very low rate of injury. Ureteric ligation was the most common mechanism of injury (47%). Injuries were intraoperatively recognized in 41.2% (7/17) of cases. Patients were treated by either endourological or formal surgical repair. The overall success rate after an average of 32.3 months of follow-up was achieved in 89.5% (17/19). This outcome was not significantly altered by either the features of injury or by the treatment schedules.

CONCLUSION: Iatrogenic ureteric injury is still a major cause of harm and concern. The time taken to detect the injury remains the most important morbidity-related factor. Recent trends towards earlier intervention and the use of various endourological means of repair deserve support and promotion.