Surgical Repair of Iatrogenic Ureteral Injury Secondary to Gynecologic Surgery

Operative injuries to the urinary tract are common during the course of gynecological surgery due to close development and proximity of the urogenital organ systems. Its incidence is low but ureteric injury may have serious implications in terms of morbidity. The retrospective and descriptive study was carried out in the urological department of Clinical Hospital "Prof.Dr.Theodor Burhele", Bucharest. 24 cases with iatrogenic ureteral injury were included, between January 2010-January 2015. The following parameters were studied: age, cause of primary surgery, association of radiotherapy, type of injury, treatment, complications and results and follow-up. Hysterectomy, associated or not with radiotherapy, was detected as primary risc in ureteral iatrogenic injury. The age range was between 29 to 76 years old, with a mean of 51 years. In 15 of 24 cases the patient undergone radical hysterectomy for cervical cancer, 8 cases undergone hysterectomy for uterus fibroma and in 1 case the cause of intervention was a C-section. 13 patients needed also radiotherapy while 11 of them were not subjects to radiotherapy. In 18 cases urethero hidronephrosys (II-IV) was present due to a pelvic ureteral stenosis. In 4 cases the patients presented uretero-vaginal fistula and 2 patients presented uroperitoneum with ureteroperitoneal fistula. 14 cases were submitted to repair surgery while 9 cases were subject to JJ stent only and in 1 case permanent nephrostomy was needed. 8 of 14 cases which were subjects to repair surgery had not encountered perioperative or late complications. In 2 cases secondary nephrectomy was needed due to repeated pielonephritis . In other 2 cases a secondary ureteroneocystostomy was needed, In 1 case recurrent neoplasm was recorded and patient needed permanent bilateral nephrostomy and in 1 case persistent ureterohydronephrosis was noted and the pacient was subject to permanent nephrostomy and JJ stent.Iatrogenic ureteral lesions are common in gynecologic surgery and have a great impact on morbidity. Gynecologists should be aware of urologic injury during surgery and should always take preventive measures.