[Study of the injury to the urinary system caused by radiological vascular interventional therapy of obstetrical and gynecological benign diseases].

OBJECTIVE

To explore the injuries to the urinary system caused by uterine artery embolization (UAE) for treatment of obstetrical and gynecological benign diseases, including the classification, aetiology, therapy of the injuries and precaution methods.

METHODS

The injuries of the urinary system were reviewed in 960 cases of obstetrical and gynecological benign diseases treated with UAE by our interventional centre. Of all 960 cases, 690 cases were myoma, 244 adenomyosis, 8 cervical pregnancy, 2 cornus pregnancy, 14 postpartum hemorrhage, 2 late postpartum hemorrhage. Meanwhile, the correlative problems of the vascular anatomy, DSA and the embolization technics of microcatheter were analyzed.

RESULTS

(1) Different degrees of urinary system injuries occurred in 5 of 960 cases, the rate was 0.5%. None was severe injury, one case (0.1%) was moderate injury, and the patient suffered of hydronephrosis caused by segmental necrosis of unilateral ureter. Mild injury occurred in 4 cases (0.4%), including one case of inflammation of bladder, one case of partial necrosis of bladder mucosa membrane, 2 cases of transient slight unilateral hydronephrosis. Among all the injuries, 4 occurred in myoma patients, and one occurred in adenomyosis patient. The operation procedures of all five cases were bilateral uterine artery embolization, and none used microcatheter. (2) The ureter branch arising from the middle or lower part of the uterine artery supplied the middle or lower part of ureter and the length of this part of ureter is about 4 cm, the bladder branch arising from the middle or lower part of uterine artery supplied the bladder and communicated with the bladder vascular net. Correlative injuries could be caused by the retroflow of embolisms into the above arteries. (3) Placement of the catheter into the upper branch of the uterine artery or the tumor vascular net, using microcatheter if necessary and notation of the retroflow in the embolization process could avoid the embolization of bladder and ureter arteries. (4) Totally 506 cases used microcatheter, the ratio was 52.7%. The 5 cases of injuries did not use microcatheter.

CONCLUSIONS

Injuries to the urinary system could occur in UAE for treatment of obstetrical and gynecological benign diseases, which can be prevented by carefully differentiating the vascular communicating branch and the conditions of branches, and embolization of the upper branch of uterine artery can avoid the injury.