IATROGENIC URETERIC INJURIES IN GYNECOLOGICAL SURGERY

Abstract

Although the ureter is protected from injury by virtue of its elasticity and sheltered position, it is highly
vulnerable during surgical procedures performed in pelvis. Nearly all gynecological surgical procedures have
been reported to cause ureteral injury. Incidence of ureteral injury for benign conditions is low but it is on
the rise owing to the enthusiastic use of therapeutic laparoscopy in gynaecology. Factors associated with
increased risk of ureteral injury include malignancy, hemorrhage, endometriosis, adhesions from previous
surgery, enlarged uterus and distorted anatomy. During surgery ureter may be transected, lacerated, avulsed,
ligated or diathermized. Injury may become obvious intra-operatively but most cases are diagnosed in
postoperative period. The morbidity associated with such an injury may be serious resulting in prolonged
hospital stay, re-operation and potential loss of renal function. Injury recognized intra-operatively should
be repaired during the same procedure. When the diagnosis of ureteral injury is made post-operatively,.then
either endourological or open surgical procedures may be performed with good success. In the presence of
risk factors pre-operative intravenous urography, ureteric stenting may be carried out but sound knowledge
of abdominal and pelvic anatomy is the best prevention for ureteric injury.