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. 2018 Sep;29(9):1303-1309.
doi: 10.1007/s00192-017-3483-4. Epub 2017 Oct 11.

Diagnosis and management of 365 ureteric injuries following obstetric and gynecologic surgery in resource-limited settings

Thomas J I P Raassen  1 , Carrie J Ngongo  2 , Marietta M Mahendeka  3
Affiliations

Diagnosis and management of 365 ureteric injuries following obstetric and gynecologic surgery in resource-limited settings

Thomas J I P Raassen et al. Int Urogynecol J. 2018 Sep.

Abstract

Introduction: Ureteric injuries are among the most serious complications of pelvic surgery. The incidence in low-resource settings is not well documented.

Methods: This retrospective review analyzes a cohort of 365 ureteric injuries with ureterovaginal fistulas in 353 women following obstetric and gynecologic operations in 11 countries in Africa and Asia, all low-resource settings. The patients with ureteric injury were stratified into three groups according to the initial surgery: (a) obstetric operations, (b) gynecologic operations, and (c) vesicovaginal fistula (VVF) repairs.

Results: The 365 ureteric injuries in this series comprise 246 (67.4%) after obstetric procedures, 65 (17.8%) after gynecologic procedures, and 54 (14.8%) after repair of obstetric fistulas. Demographic characteristics show clear differences between women with iatrogenic injuries and women with obstetric fistulas. The study describes abdominal ureter reimplantation and other treatment procedures. Overall surgical results were good: 92.9% of women were cured (326/351), 5.4% were healed with some residual incontinence (19/351), and six failed (1.7%).

Conclusions: Ureteric injuries after obstetric and gynecologic operations are not uncommon. Unlike in high-resource contexts, in low-resource settings obstetric procedures are most often associated with urogenital fistula. Despite resource limitations, diagnosis and treatment of ureteric injuries is possible, with good success rates. Training must emphasize optimal surgical techniques and different approaches to assisted vaginal delivery.

Keywords: Fistula; Iatrogenic; Injury; Reimplantation; Ureter; Ureteric.

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Conflict of interest statement

None

References

    1. Selzman AA, Spirnak JP. Iatrogenic ureteral injuries: a 20-year experience in treating 165 injuries. J Urol. 1996;155:878–881. doi: 10.1016/S0022-5347(01)66332-8. - DOI - PubMed
    1. Harkki-Siren P, Sjoberg J, Titinen AL. Urinary tract injuries after hysterectomy. Obstet Gynecol. 1998;92(1):113–118. doi: 10.1016/S0029-7844(98)00146-X. - DOI - PubMed
    1. Rajasekar D, Hall M. Urinary tract injuries during obstetric intervention. Br J Obstet Gynaecol. 1997;104:731–734. doi: 10.1111/j.1471-0528.1997.tb11986.x. - DOI - PubMed
    1. Eisenkop SM, Richman R, Platt LD, Paul RH. Urinary tract injury during cesarean section. Obstetrics & Gynecology 60. No. 1982;5:591–596. - PubMed
    1. Hilton P (2016) Trends in the aetiology of urogenital fistula: a case of retrogressive evolution? Int Urogynecol J, Special Edition: 1–7. - PMC - PubMed

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