Departments of Surgery and Basic Medical Science, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana.
Ho Teaching Hospital, Ho, Volta Region, Ghana.
BMC Surg. 2022 Nov 5;22(1):380. doi: 10.1186/s12893-022-01817-3.
Seventy percent of ureteric injuries result from iatrogenic causes with about 75% of these diagnosed in the postoperative period. It may have fatal complications such as sepsis and or renal functional damage increasing morbidity and treatment cost.
The study aimed to identify the risk factors for iatrogenic ureteric injuries from open surgical procedures and the intervention outcome in a resource-poor setting.
This was a multi-centre study. The clinical records of patients with iatrogenic ureteric injuries seen between 2015-2021 who were managed at the urology units of the Margaret Marquart Catholic Hospital, and the Ho Teaching Hospital, in the Volta region of Ghana, were retrieved. The data extracted included patients' demographic factors, the clinical presentation, the primary surgery details, the time from surgery to presentation, the intervention offered, and the outcomes. The data were analysed using the Statistical Package for Social Scientists (SPSS) version 24.0.
Twelve patients aged between 24-54 years with a total of 19 ureteric injuries were managed. The injuries resulted from a hysterectomy in 10 cases (83.3%), and one each from emergency caesarean section and inguinal hernia repair with traction and transection injuries respectively (16.7%). Seven out of 12 cases were diagnosed 48 h after surgery. Bilateral injuries occurred in 7 cases (14/19 injuries). Intraoperative recognition was common in unilateral injuries and surgeries performed by specialist surgeons. Ureteroneocystostomy (14/19), uretero-ureterostomy (1/19), and open suture release were the management procedures performed as in the intervention.
Open hysterectomy (83.7%) was the most common procedure leading to iatrogenic ureteric injuries in this study. Intra-operative recognition occurred when trained specialist surgeons performed the surgery. Late presentation with more severe morbidity was found amongst non-specialist surgeons. Thus, improvement in training to allow intra-operative diagnosis should be encouraged in general practitioners to reduce morbidity and improve outcomes.
70%的输尿管损伤是医源性的，其中约 75%是在术后诊断的。它可能导致致命的并发症，如败血症和/或肾功能损害，增加发病率和治疗费用。
本研究旨在确定资源匮乏环境下开放性手术导致医源性输尿管损伤的危险因素和干预结果。
这是一项多中心研究。回顾了 2015 年至 2021 年间在加纳沃尔特地区玛格丽特·马克特天主教医院和霍教学医院泌尿科接受治疗的医源性输尿管损伤患者的临床记录。提取的数据包括患者的人口统计学因素、临床表现、主要手术细节、从手术到就诊的时间、提供的干预措施和结果。数据使用社会科学统计软件包（SPSS）第 24.0 版进行分析。
共管理了 12 名年龄在 24-54 岁之间的患者，共 19 例输尿管损伤。损伤由 10 例（83.3%）子宫切除术引起，另有 1 例分别由紧急剖宫产和腹股沟疝修补术引起，分别为牵引和横断损伤（16.7%）。12 例中有 7 例在手术后 48 小时内被诊断出来。7 例（14/19 例损伤）为双侧损伤。单侧损伤和由专科医生进行的手术常能在术中识别。实施的处理程序包括输尿管-肾盂吻合术（14/19）、输尿管-输尿管吻合术（1/19）和开放性缝合松解术。
在本研究中，开放性子宫切除术（83.7%）是导致医源性输尿管损伤最常见的手术。当训练有素的专科医生进行手术时，会在术中识别。在非专科医生中发现，晚期出现更严重的发病率。因此，应该鼓励普通医生加强培训，以允许术中诊断，从而降低发病率并改善结果。
