Functional outcomes of surgical treatment of ureteral injury following gynecological and obstetrical surgery

Moez Rahoui; Yassine Ouanes; Kays Chaker; Kheireddine Mourad Dali; Mokhtar Bibi; Ahmed Sellami; Sami Ben Rhouma; Yassine Nouira

doi:10.1016/j.amsu.2022.104067

Functional outcomes of surgical treatment of ureteral injury following gynecological and obstetrical surgery

Ann Med Surg (Lond). 2022 Jun 28:79:104067. doi: 10.1016/j.amsu.2022.104067. eCollection 2022 Jul.

Authors

Moez Rahoui¹, Yassine Ouanes¹, Kays Chaker¹, Kheireddine Mourad Dali¹, Mokhtar Bibi¹, Ahmed Sellami¹, Sami Ben Rhouma¹, Yassine Nouira¹

Affiliation

¹ Urology Department La Rabta Hospital, Tunis, Tunisia.

Abstract

Introduction: Iatrogenic ureteral lesions represent one of the serious complications that can follow obstetric and gynecological surgery. This condition has a fatal consequence on renal function if it's not promptly diagnosed and managed.

Objective: The aim of our study was to report our experience in the management of this pathology.

Materials & methods: This is a retrospective study of 32 patients treated for an iatrogenic ureteral injury after gynecological or obstetrical surgery, collected in the urology department of the Rabta Hospital over a 15-year period (2005-2020). Clinical presentation, investigations, and operative and postoperative details were reviewed from the patients' charts.

Results: The average age of the patients was 42.6 (21-61). Multiparity was observed in 90.6% of cases. Hysterectomy was the most common cause (71.87%), followed by cesarean operation (18.75%), mainly for patients with placenta percreta (12.5%), and lastly, cure of prolapse by the upper approach in 9.37% of cases. The symptoms were dominated by low back pain and urinary incontinence. Stenosis was the most frequent lesion in 25 cases, followed by a section in 4 cases. A ureterovaginal fistula was observed in 3 case s. The first-line treatment of the patients was drainage by a ureteral stent (15.6%) or by a percutaneous nephrostomy (84.4%). Ureterovesical reimplantation was performed in 26 cases (81.25%). However, one patient had an Ileal ureter replacement. During follow-up, treatment failure was noted in 7 patients. Four patients developed secondary hydronephrosis treated with a urethral stent while 3 patients required nephrectomy. The type of gynecological and obstetrical procedure (open hysterectomy), history of pelvic surgery, and malignant pathology were predictive factors of treatment failure.

Conclusions: Injuries to the ureter during gynecological and obstetrical surgery are generally rare. The diversity of repair techniques and the contribution of endo-urological techniques most often allow renal preservation, knowing that the best treatment remains prevention.

Keywords: Hysterectomy; Iatrogenic ureteral injury; Ureteral ligation; Ureterovesical reimplantation.