Our Experience with Iatrogenic Ureteric Injuries Following Obstetric and Gynaecological Surgery at a Tertiary Care Center

Abstract

Objective: To study the pattern of presentation, diagnosis and management outcome of ureteric injury sustained during obstetric and gynaecological surgery. Study Design: Case series. Place and Duration of Study: Armed Forces Institute of Urology Combined Military Hospital, Lahore Pakistan, from Nov 2010 to Nov 2020. Methodology: Eighty-three patients satisfying inclusion criteria (suspected ureteric injury after gynaecological/obstetric intervention) were included. Demographic details, primary surgeon, presenting features, diagnostic workup, treatment instituted, complications, and success were recorded and analyzed. Results: The study analyzed 83 patients with a mean age of 44.6±10.8 years and a mean parity of 3.4±1.4 children. The ovarian tumour was the most common cause of primary surgery (32, 38.6%), and the majority (64,77.1%) involved less experienced gynaecologists. Flank/abdominal pain was the main presentation (56, 67.5%), followed by oliguria. The left ureter was affected in the majority (58, 69.9%). Ureteric re-implant (37, 44.5%) and JJ stenting (33, 39.8%) constituted major urological interventions. Only three patients (3.6%) had surgical failure; two of them died, while one had redo surgery.Conclusion: Iatrogenic ureteric injury mostly follows radical gynaecological procedures and must be suspected in case of pain in the abdomen or vague constitutional symptoms after pelvic surgery. Management is dictated by location, time interval, diagnosis, and available surgical expertise.