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.
Similar content being viewed by others
References
Cormio L, Battaglia M, Traficante A, Selvaggi FP. Endourological treatment of ureteric injuries.Br J Urol 1993;72:165–168
Assimos DG, Patterson LC, Taylor CL. Changing incidence and etiology of iatrogenic ureteral injuries.J Urol 1994;152:2240–2246
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
Mattingly RF, Borkowf HI. Acute operative injury to the lower urinary tract.Clin Obstet Gynecol 1978;5:123–149
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
Fry DE, Milholen L, Harbrecht PJ. Iatrogenic ureteral injury.Arch Surg 1983;118:454–457
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
Mendez R, McGinty DM. The management of delayed recognized ureteral injuries.J Urol 1978;119:192–193
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
Carlton CE, Scott R, Guthrie AG. The initial management of ureteral injuries: a report of 78 cases.J Urol 1971;105:335–340
Dowling RA, Coriere JN, Sandler CM, Iatrogenic ureteral injury.J Urol 1986;135:912–915
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
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
Blandy JP, Anderson JD. Management of the injured ureter.Proc Roy Soc Med 1977;70:187–188
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
Zinman LM, Libertino JA, Roth RA. Management of operative ureteral injury.Urology 1978;12:290–303
Smith IB, Smith JC. Trans-uretero-ureterostomy: British experience.Br J Urol 1975;47:519–523
Noble JG, Lee KT, Mundy AR. Transuretero-ureterostomy: a review of 253 cases.Br J Urol 1997;79:20–23
Hensle TW, Burbige KA, Levin RK. Management of the short ureter in urinary tract reconstruction.J Urol 1987;137:707–711
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
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
Witters S, Cornelissen M, Vereecken R. Iatrogenic ureteral injury: aggressive or conservative treatment.Am J Obstet Gynecol 1986;155:582–584
Chang R, Marshall FR, Mitchell S. Percutaneous management of benign ureteral strictures and fistulas.J Urol 1987;137:1126–1131
Meretyk S, Albala DM, Clayman RV, Denstedt JD, Kavoussi LR. Endoureterotomy for treatment of ureteral strictures.J Urol 1992;147:1502–1506
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
Raney AM. Ureteral trauma: effects of ureteral ligation with and without deligation-experimental studies and case reports.J Urol 1978;119:326–329
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
Gomel V, James C. Intraoperative management of ureteral injury during operative laparoscopy.Fertil Steril 1991;55:416–419
Schapira M, Dizerens H, Essinger A, Wauters JP, Loup P, von Niederhausern W. Urinary ascites after gynecological laparoscopy.Lancet 1978;i:871–872
Aslan P, Woo HH. Ureteric injury following laparoscopic colposuspension.Br J Obstet Gynaecol 1997;104:266–268
Phipps JH, Tyrrell NJ. Transilluminating ureteric stents for preventing operative ureteric damage.Br J Obstet Gynaecol 1992;99:81
St Lezin MA, Stoller ML. Surgical ureteral injuries.Urology 1991;38:497–506
Brudenell M. Medico-legal aspects of ureteric damage during abdominal hysterectomy.Br J Obstet Gynaecol 1996;103:1180–1183
Shapland DEP. Medico-legal aspects of ureteric damage during abdominal hysterectomy [letter].Br J Obstet Gynaecol 1997;104:753
Smith JC. How to avoid litigation: the urologist's view.Br J Urol 1997;80(Suppl 1):33–34
Higgins CC. Ureteral injuries during surgery. A review of 87 cases. JAMA 1967;199:118–124
Author information
Authors and Affiliations
Rights 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
Issue Date:
DOI: https://doi.org/10.1007/BF01982219