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Management of iatrogenic ureteric injuries associated with gynecological surgery

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Abstract

Objective: This retrospective study defines the presentation and managementof iatrogenic ureteric injuries consequent upon gynecological surgery in ateaching hospital in Punjab, Pakistan.Patients and methods: 18 patients with median age 35 years (range 18–80years) with iatrogenic ureteric injuries associated with gynecological surgerywere referred to the department of urology at Nishtar Hospital Multan Pakistan.Main presenting symptoms were urinary incontinence, loin pain and anuria.Median time since injury and presentation was 3 weeks (range 1 day to 7 years). In 16 (88%) patients injury resulted from abdominal hysterectomy. Othercauses included ovarian cystectomy (one patient) and vaginal hysterectomy (onepatient). 11 (61%) patients had ureterovaginal fistula, 5 (28%) patients hadcomplete unilateral ureteric obstruction and 2 (11%) patients had bilateral ureteric obstruction and anuria. In 11 patients with ureterovaginal fistula ureteroneocystostomy was performed. In five patients with unilateral uretericobstruction, one had end to end anastomosis of ureter, three had ureteroneocystostomy only and one had ureteroneocystostomy and psoas hitch done. Two had anuriasecondary to bilateral ureteric obstruction. In one of these patients Boari flapand ureteroneocystostomy was carried out. The second patient had deligation ofcatgut sutures on ipsilateral side and ureteroneocystostomy on the contra-lateralside.Results: In 17 patients no major complication occurred. One patient whohad deligation of catgut sutures, the distal ureter sloughed and re-explorationand ureteroneocystostomy was performed. Renal salvage was achieved in all cases.Conclusion: Open surgical procedures for repair of iatrogenic uretericinjuries are associated with good outcome. Strategies to prevent these injuriesinclude adequate surgical training and meticulous surgical techniques.

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Authors and Affiliations

  1. 5, Altaf Town, Tariq Road, Multan, Pakistan

    Muhammad Rafique

  2. Nishtar Medical College, Multan, Pakistan

    M. Hanif Arif

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  1. Muhammad Rafique
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  2. M. Hanif Arif
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Correspondence to Muhammad Rafique.

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Rafique, M., Arif, M.H. Management of iatrogenic ureteric injuries associated with gynecological surgery. Int Urol Nephrol 34, 31–35 (2002). https://doi.org/10.1023/A:1021320409583

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