Departments of Obstetrics & Gynecology, School of Medicine, West Virginia University, PO Box 9186, Robert C. Byrd Health Sciences Center, Morgantown, WV, 26506, USA.
Int Urogynecol J. 2020 Feb;31(2):359-363. doi: 10.1007/s00192-019-03949-2. Epub 2019 Apr 16.
Ureteral injuries are a source of morbidity, and delays in diagnosis can increase the risk for long-term sequelae. Our aim was to quantify and describe iatrogenic ureteral injuries in a rural tertiary care center. Our secondary goal was to evaluate the impact of delayed diagnosis of ureteral injury on patient outcomes and whether cystoscopy had any influence on these outcomes.
A retrospective chart review was undertaken for ureteral injuries, identified by the ICD-9 code from 1997 to 2017 at West Virginia University (WVU) Hospital. Injuries were categorized by procedure, surgeon specialty, location (WVU versus community hospital), and intraoperative cystoscopy. A delay in diagnosis was defined as a ureteral injury sustained during surgery not diagnosed intraoperatively.
Forty-six patients were identified with iatrogenic ureteral injury at WVU. Twenty-seven occurred during gynecologic procedures (59%). Fourteen ureteral injuries were sustained at community hospitals and transferred to WVU for evaluation and treatment. Fifty percent of those had a known delay in diagnosis. The average delay in diagnosis for transferred patients was 6.5 days vs. 3.6 days for patients with ureteral injury sustained at WVU. Cystoscopy was only utilized in 37% (10/27) of gynecologic cases involving a ureteral injury. When cystoscopy was utilized, it was 80% (8/10) effective in helping to identify ureteral injury.
Within a rural population, approximately half of patients with ureteral injuries were transferred to a tertiary care center for evaluation and treatment. Transferred patients were more likely to have a delay to diagnosis than patients who had injuries sustained at WVU. The delayed diagnosis patients had comparatively worse outcomes. Gynecologic surgeons working in rural hospitals should be adequately trained to perform diagnostic cystoscopy.
输尿管损伤是发病率的一个来源，诊断的延迟会增加长期后遗症的风险。我们的目的是量化和描述农村三级保健中心的医源性输尿管损伤。我们的次要目标是评估输尿管损伤的延迟诊断对患者结局的影响，以及膀胱镜检查是否对这些结局有任何影响。
对 1997 年至 2017 年在西弗吉尼亚大学（WVU）医院通过 ICD-9 编码识别的输尿管损伤进行了回顾性病历审查。根据手术程序、外科医生专业、位置（WVU 与社区医院）和术中膀胱镜检查对损伤进行分类。诊断延迟定义为术中未诊断出手术中发生的输尿管损伤。
在 WVU 共发现 46 例医源性输尿管损伤患者。27 例发生在妇科手术中（59%）。14 例输尿管损伤发生在社区医院，并转至 WVU 进行评估和治疗。其中 50%有已知的诊断延迟。转院患者的平均诊断延迟时间为 6.5 天，而 WVU 发生输尿管损伤的患者为 3.6 天。膀胱镜检查仅用于 27%（10/27）涉及输尿管损伤的妇科病例。当使用膀胱镜检查时，它在 80%（8/10）的情况下有助于识别输尿管损伤。
在农村人群中，大约一半的输尿管损伤患者被转至三级保健中心进行评估和治疗。转院患者比 WVU 发生损伤的患者更有可能出现诊断延迟。延迟诊断的患者结局较差。在农村医院工作的妇科医生应接受充分的诊断性膀胱镜检查培训。
