Ureteral injuries complicating gynecologic surgery

Abstract

Iatrogenic ureteral lesions may occur after any pelvic surgery. They are severe and can affect renal function and even vital prognosis. This study aimed to determine the clinical aspects and the therapeutic approaches of this injury. We conducted a retrospective study of six patients with iatrogenic ureteral lesions following gynecologic or obstetric surgery whose data were collected in the Department of Urology in Kairouan on a period of 4 years (2012-2016). The average age of our patients was 46 years. They were all multiparous. Clinical symptoms were variable depending on the type of lesion. Intravenous urography is very useful for diagnosis. It was performed in 4 cases showing abnormalities. Treatment was based on the insertion of a catheter in one case and on 5 uretero-vesical reimplantations. The postoperative course was marked by a nephrectomy. Iatrogenic ureteral lesions have become a rarity. They are correlated with the degree of medicalization in the country. Gynecological and obstetric surgery is the main cause of iatrogenic ureteral lesions. Prognosis is conditioned by early diagnosis and the anatomic condition of the ureter.