Management and Long-Term Follow-Up of Ureteric Injuries During Radical Hysterectomy: Single Center Experience

Abstract

Damage to the lower ureters during pelvic surgery is a serious and well-recognized complication. In most series, ureteric injury occurred in 0.5%-1.0% of all pelvic operations. The incidence of ureteric injuries is high with extensive abdominal operations for carcinoma of cervix (1.5%-2.5%) more so with patients who had preoperative radiotherapy. We treated 34 women with iatrogenic ureteric injuries during a 20-year period following radical hysterectomy for carcinoma cervix. The time of recognition of injury in 25 cases was during primary surgery and treated immediately. Surgery was uneventful in 9 patients of whom 7 presented in the early postoperative period and 2 during follow-up. These patients were managed by ureteroneocystostomy, percutaneous nephrostomy (PCN), and double J (DJ) stenting. All the renal units were salvaged. Immediate ureteric repair is advocated for all injuries discovered intraoperatively. Action to prevent the development of iatrogenic ureteral injury must be taken in advance, and the management of ureteric injuries could be improved with prompt recognition and repair by a skilled surgeon. Unrecognized injuries cause prolonged morbidity, and their management can be difficult.