Abstract
IntroductionUreteric injuries are among the most serious complications of pelvic surgery. The incidence in low-resource settings is not well documented.MethodsThis retrospective review analyzes a cohort of 365 ureteric injuries with ureterovaginal fistulas in 353 women following obstetric and gynecologic operations in 11 countries in Africa and Asia, all low-resource settings. The patients with ureteric injury were stratified into three groups according to the initial surgery: (a) obstetric operations, (b) gynecologic operations, and (c) vesicovaginal fistula (VVF) repairs.ResultsThe 365 ureteric injuries in this series comprise 246 (67.4%) after obstetric procedures, 65 (17.8%) after gynecologic procedures, and 54 (14.8%) after repair of obstetric fistulas. Demographic characteristics show clear differences between women with iatrogenic injuries and women with obstetric fistulas. The study describes abdominal ureter reimplantation and other treatment procedures. Overall surgical results were good: 92.9% of women were cured (326/351), 5.4% were healed with some residual incontinence (19/351), and six failed (1.7%).ConclusionsUreteric injuries after obstetric and gynecologic operations are not uncommon. Unlike in high-resource contexts, in low-resource settings obstetric procedures are most often associated with urogenital fistula. Despite resource limitations, diagnosis and treatment of ureteric injuries is possible, with good success rates. Training must emphasize optimal surgical techniques and different approaches to assisted vaginal delivery.
Highlights
Ureteric injuries are among the most serious complications of pelvic surgery
All except two anuric women presented with ureterovaginal fistulas: one after cesarean sections (CS) and one after total abdominal hysterectomy (TAH)
Women whose ureteric injury occurred during obstetric fistula repair suffered longer before treatment
Summary
Ureteric injuries are among the most serious complications of pelvic surgery. Ureteric injury is a potential complication of any pelvic operation [1]. Urinary tract injuries are among the most serious complications of gynecologic surgery [2] and can occur due to an inadvertent nick, cut, or tie of the distal ureter near the cervix as it crosses uterine vessels. Several authors have estimated the incidence of urinary tract injury, which includes ureteric injury, in well-resourced settings. Including all hysterectomies and routine gynecologic pelvic operations, the incidence is reported as 22 per 1000 [1]. These wide-ranging estimates may include radical hysterectomies and laparoscopic procedures, which involve a greater risk of damage to the ureters. Ureteric injuries during hysterectomies more than doubled (0.29– 0.66%) in a comparison of two 5-year periods in England, attributable to adverse patterns of care [5]
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