{"paper_id":"95f61f66-ec12-437a-ab78-1c1f252205d1","body_text":"Prediction of Periureteral Adhesions by Drop Infusion Pyelography Before Laparoscopic Hysterectomy: A Retrospective Study\nABSTRACT\nAim\nTo identify the predictors for periureteral adhesions preoperatively.\nMethods\nPreoperative predictors for periureteral adhesions were evaluated in 407 patients who underwent laparoscopic hysterectomy (LH) for benign uterine diseases in our hospital between 2013 and 2022.\nResults\nPeriureteral adhesions were observed in 57 patients (14%). Multivariate analysis identified the following predictors for periureteral adhesions: endometriosis (odds ratio (OR), 8.54; 95% confidence interval (CI), 1.51–48.30; p < 0.05), obliteration of Douglas' pouch (OR, 89.50; 95% CI, 5.07–1580.03; p < 0.01), and ureteral flexion on drop infusion pyelography (DIP) (OR, 647.00; 95% CI, 63.00–6650.02; p < 0.001). Ureteral flexion on DIP diagnosed periureteral adhesion most accurately (sensitivity: 93.0%, specificity: 95.1%, accuracy: 94.8%). Operation time to complete LH was significantly longer in the adhesion group than in the non-adhesion group (162 min vs. 148 min; p < 0.01). Iatrogenic ureteral injury (IUI) was more common in the adhesion group than in the non-adhesion group (OR, 19.14; 95% CI, 1.51–1013.84; p < 0.01).\nConclusion\nThese results suggest that preoperative DIP is a useful predictor of periureteral adhesions. Preoperative preventive measures for IUI, such as ureteral stenting, are important in cases where severe adhesions are suspected.\nDisclosure\nAn earlier version of this article was presented at the 77th Annual Congress of the Japan Society of Obstetrics and Gynecology, held in Okayama, Japan, on May 23–25, 2025.\nConflicts of Interest\nDr. Hiroaki Komatsu is an Editorial Board member of this submitted Journal of Obstetrics and Gynaecology Journal and a co-author of this article. To minimize bias, they were excluded from all editorial decision-making related to the acceptance of this article for publication. Other authors declare no conflicts of interest.\nData Availability Statement\nData available on request due to privacy/ethical restrictions. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Although the data are anonymized, the Ethics Committee has not permitted their sharing because they contain information that could be used to identify individuals when matched with other data. If the data needs to be provided to a third party, the authors will need to obtain permission from the Ethics Committee again.","source_license":"public-domain-us","license_restricted":false}