Skip to main content

Ureteric trauma in gynecologic surgery

Abstract

Nearly 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. Tyes 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.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Cormio L, Battaglia M, Traficante A, Selvaggi FP. Endourological treatment of ureteric injuries.Br J Urol 1993;72:165–168

    PubMed  Google Scholar 

  2. 2.

    Assimos DG, Patterson LC, Taylor CL. Changing incidence and etiology of iatrogenic ureteral injuries.J Urol 1994;152:2240–2246

    PubMed  Google Scholar 

  3. 3.

    Meirow D, Moriel EZ, Zilberman M, Farkas A. Evaluation and treatment of iatrogenic ureteral injuries during obstetric and gynecologic operations for nonmalignant conditions.J Am Coll Surg 1994;178:144–148

    PubMed  Google Scholar 

  4. 4.

    Mattingly RF, Borkowf HI. Acute operative injury to the lower urinary tract.Clin Obstet Gynecol 1978;5:123–149

    Google Scholar 

  5. 5.

    Blandy JP, Badenoch DF, Fowler CG, Jenkins BJ, Thomas NWM. Early repair of iatrogenic injury to the ureter or bladder after gynecological surgery.J Urol 1991;146:761–765

    PubMed  Google Scholar 

  6. 6.

    Fry DE, Milholen L, Harbrecht PJ. Iatrogenic ureteral injury.Arch Surg 1983;118:454–457

    PubMed  Google Scholar 

  7. 7.

    Flynn JT, Tiptaft RC, Woodhouse CRJ, Paris AMI, Blandy JP. The early and aggressive repair of iatrogenic ureteric injuries.Br J Urol 1979;51:454–457

    PubMed  Google Scholar 

  8. 8.

    Mendez R, McGinty DM. The management of delayed recognized ureteral injuries.J Urol 1978;119:192–193

    PubMed  Google Scholar 

  9. 9.

    Mattson T. Frequency and management of urological and some other complications following radical surgery for carcinoma of the cervix uteri stages I & II.Acta Obstet Gynecol Scand 1975;54:271–280

    PubMed  Google Scholar 

  10. 10.

    Carlton CE, Scott R, Guthrie AG. The initial management of ureteral injuries: a report of 78 cases.J Urol 1971;105:335–340

    PubMed  Google Scholar 

  11. 11.

    Dowling RA, Coriere JN, Sandler CM, Iatrogenic ureteral injury.J Urol 1986;135:912–915

    PubMed  Google Scholar 

  12. 12.

    Sieben DM, Howerton L, Amin M, Holt H, Lich R. The role of ureteral stenting in the management of surgical injury of the ureter.J Urol 1978;119:330–331

    PubMed  Google Scholar 

  13. 13.

    Bowsher WG, Shah PJR, Costello AJ, Tiptaft RC, Paris AMI, Blandy JP. A critical appraisal of the Boari flap.Br J Urol 1982;54:682–685

    PubMed  Google Scholar 

  14. 14.

    Blandy JP, Anderson JD. Management of the injured ureter.Proc Roy Soc Med 1977;70:187–188

    PubMed  Google Scholar 

  15. 15.

    Turner-Warwick R, Worth PHL. The psoas bladder-hitch procedure for the replacement of the lower third of the ureter.Br J Urol 1969;41:701–709

    PubMed  Google Scholar 

  16. 16.

    Zinman LM, Libertino JA, Roth RA. Management of operative ureteral injury.Urology 1978;12:290–303

    Article  PubMed  Google Scholar 

  17. 17.

    Smith IB, Smith JC. Trans-uretero-ureterostomy: British experience.Br J Urol 1975;47:519–523

    PubMed  Google Scholar 

  18. 18.

    Noble JG, Lee KT, Mundy AR. Transuretero-ureterostomy: a review of 253 cases.Br J Urol 1997;79:20–23

    PubMed  Google Scholar 

  19. 19.

    Hensle TW, Burbige KA, Levin RK. Management of the short ureter in urinary tract reconstruction.J Urol 1987;137:707–711

    PubMed  Google Scholar 

  20. 20.

    Giberti C, Germinale F, Lillo M, Bottino P, Simonato A, Carmignani G. Obstetric and gynaecological ureteric injuries: treatment and results.Br J Urol 1996;77:21–26

    PubMed  Google Scholar 

  21. 21.

    Lask D, Abarbanel J, Luttwak Z, Manes A, Mukamel E. Changing trends in the management of iatrogenic ureteral injuries.J Urol 1995;154:1693–1695

    Article  PubMed  Google Scholar 

  22. 22.

    Witters S, Cornelissen M, Vereecken R. Iatrogenic ureteral injury: aggressive or conservative treatment.Am J Obstet Gynecol 1986;155:582–584

    PubMed  Google Scholar 

  23. 23.

    Chang R, Marshall FR, Mitchell S. Percutaneous management of benign ureteral strictures and fistulas.J Urol 1987;137:1126–1131

    PubMed  Google Scholar 

  24. 24.

    Meretyk S, Albala DM, Clayman RV, Denstedt JD, Kavoussi LR. Endoureterotomy for treatment of ureteral strictures.J Urol 1992;147:1502–1506

    PubMed  Google Scholar 

  25. 25.

    Turner-Warwick R. Omento-ureteroplasty and omento-skin-patch substitution uretero-plasty. In: Gingell C, Abrams P, eds. Controversies and innovations in urological surgery. Berlin: Springer-Verlag, 1988;131–134

    Google Scholar 

  26. 26.

    Raney AM. Ureteral trauma: effects of ureteral ligation with and without deligation-experimental studies and case reports.J Urol 1978;119:326–329

    PubMed  Google Scholar 

  27. 27.

    Grainger DA, Soderstrom RM, Schiff SF, Glickman MG, DeCherney AH, Diamond MP. Ureteral injuries at laparoscopy: insights into diagnosis, management and prevention.Obstet Gynecol 1990;75:839–843

    PubMed  Google Scholar 

  28. 28.

    Gomel V, James C. Intraoperative management of ureteral injury during operative laparoscopy.Fertil Steril 1991;55:416–419

    PubMed  Google Scholar 

  29. 29.

    Schapira M, Dizerens H, Essinger A, Wauters JP, Loup P, von Niederhausern W. Urinary ascites after gynecological laparoscopy.Lancet 1978;i:871–872

    Article  Google Scholar 

  30. 30.

    Aslan P, Woo HH. Ureteric injury following laparoscopic colposuspension.Br J Obstet Gynaecol 1997;104:266–268

    PubMed  Google Scholar 

  31. 31.

    Phipps JH, Tyrrell NJ. Transilluminating ureteric stents for preventing operative ureteric damage.Br J Obstet Gynaecol 1992;99:81

    PubMed  Google Scholar 

  32. 32.

    St Lezin MA, Stoller ML. Surgical ureteral injuries.Urology 1991;38:497–506

    Article  PubMed  Google Scholar 

  33. 33.

    Brudenell M. Medico-legal aspects of ureteric damage during abdominal hysterectomy.Br J Obstet Gynaecol 1996;103:1180–1183

    PubMed  Google Scholar 

  34. 34.

    Shapland DEP. Medico-legal aspects of ureteric damage during abdominal hysterectomy [letter].Br J Obstet Gynaecol 1997;104:753

    Google Scholar 

  35. 35.

    Smith JC. How to avoid litigation: the urologist's view.Br J Urol 1997;80(Suppl 1):33–34

    PubMed  Google Scholar 

  36. 36.

    Higgins CC. Ureteral injuries during surgery. A review of 87 cases. JAMA 1967;199:118–124

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to M. J. Drake.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Drake, M.J., Noble, J.G. Ureteric trauma in gynecologic surgery. Int Urogynecol J 9, 108–117 (1998). https://doi.org/10.1007/BF01982219

Download citation

Keywords

  • Gynecology
  • Iatrogenic
  • Injury
  • Ureter