Abstract
Background Ureteric injuries leading to ureterovaginal fistula (UVF) is less common than vesicovaginal fistula, as a cause of urinary incontinence. Recently, there is a surge in the number of UVF cases presenting to University College Hospital (UCH) following a caesarean delivery. The urogynaecology unit at UCH is at the forefront of providing surgical repair for women with all forms of genitourinary fistulas. We describe our experience with managing UVF arising from ureteric injury. Methods A retrospective data collection of UVF cases managed from January 2012–December 2017 at UCH is presented. Information on sociodemographic and obstetric characteristics, presenting complaints, antecedent surgery, treatment received, findings at surgery, and postoperative complications were obtained with a structured proforma. Results Eighteen cases of UVFs due to iatrogenic ureteric injury were managed. Majority (N=11; 61.1%) of the women suffered the injury following the emergency caesarean section (EMCS). Abdominal hysterectomy operation accounted for four (22.2%) cases, and one case each (5.6%) was due to vaginal hysterectomy and destructive operations. Prolonged obstructed labour (POL) (81.8%) was the most common indication for the EMCS, while 18.2% had surgery on account of lower uterine segment fibroid. Most of the ureteric injuries were on the left side. Postoperative complications documented were haemorrhage, urinary tract infection, wound infection, and injury to the neighbouring structure. Conclusion Caesarean section being one of the most performed surgical operations in Nigeria was surprisingly found to be the most common cause of ureteric injury ahead of hysterectomy. It is a pointer that the surgeons might not have properly learnt the art of the caesarean delivery well. We recommend adequate surgical training of medical officers/surgeons that are involved.
Highlights
Ureteric injury resulting in ureterovaginal fistula (UVF) is an infrequent complication of abdominopelvic surgery
UVF patients suffer from prolonged hospital stay, delayed postoperative recovery time, and persistent urinary incontinence [1]. is is usually distressing to the patient because of increased morbidity, cost, and repeat surgical interventions when the initial repair fails. e reported prevalence of ureteric injuries appears to be higher in high-income countries than low-middle income countries [2]. e possible explanation is the increasing rate of minimal access surgery in the pelvic region [2]
Minimal access surgery is associated with higher risk of ureteric injury than open surgery [2]. e incidence of ureteric injury varies between 0.5 and 1.5% as a complication of open gynaecologic surgery and 0.5–14% in laparoscopic surgeries in high-income countries with higher prevalence reported among the inexperience surgeons [3]
Summary
Ureteric injury resulting in ureterovaginal fistula (UVF) is an infrequent complication of abdominopelvic surgery. E incidence of ureteric injury varies between 0.5 and 1.5% as a complication of open gynaecologic surgery and 0.5–14% in laparoscopic surgeries in high-income countries with higher prevalence reported among the inexperience surgeons [3]. Surgeons’ experience plays a critical role in reported incidence of Obstetrics and Gynecology International ureteric injury following laparoscopic gynaecologic surgeries. Some authors reported a higher incidence, while others reported comparable figures between laparoscopic and open surgeries [1, 2] Majority of these ureteric injuries occurred from laparoscopic-assisted vaginal hysterectomy [3]. Caesarean section being one of the most performed surgical operations in Nigeria was surprisingly found to be the most common cause of ureteric injury ahead of hysterectomy. We recommend adequate surgical training of medical officers/ surgeons that are involved
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