Original articleThe detection of ureteral injuries after hysterectomy
Section snippets
Patients
A review of medical records was conducted in which ureteral injuries occurred during hysterectomies performed from January 1998 through December 2003 at Changhua Christian Hospital. Three main surgical procedures were included: total abdominal hysterectomy (TAH), laparoscopic hysterectomy (LH), and total vaginal hysterectomy (TVH). Only patients who underwent surgery for nonmalignant disease were enrolled in the study, and the diagnoses included uterine leiomyoma, adenomyosis, refractory
Results
A total of 4950 hysterectomies comprised the study population: 2836 LHs, 1844 TAHs, and 270 TVHs. The frequency of LHs increased with time (Figure 1). A total of 15 patients with ureteral injuries were identified in the study. The incidence of ureteral injury was 0.32% (15/4950) in all patients undergoing hysterectomy and 0.53% (15/2836) in patients undergoing LH. Altogether, 51 patients had intraoperative cystoscopy, and 527 patients had early postoperative ureteral jet ultrasonography, all of
Discussion
Ureteral injury remains a severe complication in gynecologic surgery. The incidence of ureteral injuries is 0.1% to 0.4% in patients undergoing TAH and zero to 0.5% in patients undergoing TVH.3, 4, 5, 6, 7, 21 In our review, no ureteral injuries occurred in patients who underwent TAH or TVH. Laparoscopic surgery has largely replaced traditional surgery for most benign gynecologic conditions. In our series, 57% of hysterectomies were performed by laparoscopy, and the trend for LH continues to
Conclusion
Intraoperative cystoscopy and early postoperative ureteral jet ultrasonography are useful tools for the early diagnosis of ureteral injuries before obvious physical signs and symptoms develop. However, there are limitations for both methods. If the postoperative signs and symptoms of flank pain, costovertebral tenderness, and fever develop, a ureteral injury should be highly suspected even if previous cystoscopy or jet ultrasonography reveals bilaterally patent ureters.
Acknowledgment
We thank Miss Yu-Jun Chang, Laboratory of Epidemiology and Biostatistics at Changhua Christian Hospital, for the statistical assistance.
References (31)
- et al.
Litigation following ureteral injuries associated with gynecological surgery
J Soc Obstet Gynecol Can
(1999) - et al.
Hysterectomy in the United States
Obstet Gynecol
(1994) - et al.
Ureteral injury in gynecologic surgery: a ten-year review in a community hospital
Am J Obstet Gynecol
(1995) - et al.
Urinary tract injuries after hysterectomy
Obstet Gynecol
(1998) - et al.
Suture entrapment and secondary ureteral obstruction
Am J Obstet Gynecol
(1991) - et al.
Diagnosis and management of serious urinary complications after major operative laparoscopy
Obstet Gynecol
(1996) - et al.
Ureteral complications with operative gynecologic laparoscopy
Am J Obstet Gynecol
(1998) - et al.
The value of intra-operative cystoscopy at the time of laparoscopic hysterectomy
Hum Reprod
(1999) Ureteral injuries in gynecologic surgery
J Urol
(1953)- et al.
Ureteral injury in pelvic surgery
Obstet Gynecol
(1954)
Lower urinary tract injury during gynecologic surgery and its detection by intraoperative cystoscopy
Obstet Gynecol
Cost-effectiveness of universal cystoscopy to identify ureteral injury at hysterectomy
Obstet Gynecol
Ureteric jet effect: the echographic appearance of urine entering the bladder—a means of identifying the bladder trigone and assessing ureteral function
Radiology
Interpretation of submerged laminar jets: ureteric jet phenomenon
Radiology
Laminar submerged jets by color Doppler ultrasound: a model of the ureteral jet phenomenon
Invest Radiol
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