Ureteral trauma during open surgery: aetiology, presentation and management.

BACKGROUND

Ureteric injury during a surgical procedure is a serious complication with significant morbidity. The objective of this research was to study the aetiology, clinical features and management of iatrogenic ureteric injuries after open surgical procedures.

METHODS

This descriptive study was carried out in the Urology and Transplant unit of Institute of Kidney Diseases, Peshawar, from 1st August 2008 to 30th April 2011. Patients with clinical diagnosis of ureteral trauma due to open surgical procedures were included in the study through convenient sampling after informed consent. Important variables under study were: aetiology of ureteric injury, presenting features, time from injury to diagnosis, type of ureteric injury, treatment options, and outcome of treatment. Follow up was at 1, 3, 6 and 12 months.

RESULTS

The study included 43 patients; 33 (76.7%) were females and 10 (23.3%) males. Abdominal hysterectomy was the commonest cause 20 (46.5%) of ureteric injury. Common presenting features were urinary incontinence 13 (30.23%), flank pain 7 (16.3%) and anuria 10 (23.3%). Median time from ureteric injury to urological referral was 10 days. Distal ureter was most commonly injured. Percutaneous nephrostomy was carried out in 14 (32.5%) cases. Ureteroscopic ureteric stenting was successful in 5 (11.6%) cases. Ureteroneocystostomy was carried out 25 (58%) cases. Two (4.7%) cases presented very late with non-functioning kidneys and required nephrectomy. Patients developing ureteric stricture after ureteroneocystostomy were managed successfully by endo-urological procedures. Renal function remained stable in all the patients during follow-up and there was no mortality.

CONCLUSION

Timely recognition of ureteric injury and its management is associated with good outcome and decreased morbidity.