Diagnosis and management of iatrogenic ureteral injury in total laparoscopic hysterectomy

Yaşam Kemal Akpak, Sercan Kantarcı, Serkan Oral, Tuğkan Duran
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2021 · vol. 10(10) , pp. 4024 · doi:10.18203/2320-1770.ijrcog20213886 · W3204790521
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This paper reviews risk factors, diagnostic methods, and management strategies for iatrogenic ureteral injury during total laparoscopic hysterectomy, highlighting endometriosis as a significant risk factor.

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This review article examines the diagnosis and management of iatrogenic ureteral injuries occurring during total laparoscopic hysterectomy, noting that the risk is higher in this approach compared to abdominal or vaginal methods. The authors identify obesity, pelvic adhesions, enlarged uterus, and prior surgery as significant risk factors for such injuries. They emphasize that intraoperative cystoscopy and postoperative urinary ultrasonography are critical tools for early diagnosis, which allows for timely repair and reduces morbidity. Relevance to endometriosis: listed as a specific risk factor for ureteral injury during gynecologic surgery, though the paper's main focus is surgical complications rather than disease pathology.

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Abstract

Ureteral injury is common in gynecological surgeries due to the proximity to organs. The risk of ureteral injury is higher in laparoscopic hysterectomy operations compared to abdominal or vaginal hysterectomies. Obesity, endometriosis, pelvic adhesions, history of previous surgery, enlarged uterus, and intraoperative hemorrhage are some of the risk factors identified for ureteral injury. Intraoperative cystoscopy and postoperative urinary ultrasonography can be used in the diagnosis of early ureteral injury. Management of ureteral injury differs according to the extent, type, and localization of the injury. In evaluating the ureteral injury, early diagnosis and early repair in appropriate patients are essential in morbidity and medicolegal.
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Diagnosis and management of iatrogenic ureteral injury in total laparoscopic hysterectomy DOI: https://doi.org/10.18203/2320-1770.ijrcog20213886Keywords: Ureteral injury, Total laparoscopic hysterectomy, Cystoscopy, Ureteroureterostomy, Urinary sonographyAbstract Ureteral injury is common in gynecological surgeries due to the proximity to organs. The risk of ureteral injury is higher in laparoscopic hysterectomy operations compared to abdominal or vaginal hysterectomies. Obesity, endometriosis, pelvic adhesions, history of previous surgery, enlarged uterus, and intraoperative hemorrhage are some of the risk factors identified for ureteral injury. Intraoperative cystoscopy and postoperative urinary ultrasonography can be used in the diagnosis of early ureteral injury. Management of ureteral injury differs according to the extent, type, and localization of the injury. In evaluating the ureteral injury, early diagnosis and early repair in appropriate patients are essential in morbidity and medicolegal. Metrics References Mäkinen J, Johansson J, Tomás C, Heikkinen AM, Fraser J, Tomás E, et al. Morbidity of 10.110 hysterectomies by type of approach. Hum Reprod. 2001;16(7):1473-8. Vakili B, Chesson RR, Kyle BL, Gist R, Zheng YT, Nolan TE. The incidence of urinary tract injury during hysterectomy: A prospective analysis based on universal cystoscopy. Am J Obstet Gynecol. 2005;192(5 SPEC. ISS.):1599-604. Adelman MR, Bardsley TR, Sharp HT. Urinary Tract Injuries in Laparoscopic Hysterectomy: A Systematic Review. J Minim Invasive Gynecol. 2014;21(4):558-66. Gilmour DT, Das S, Flowerdew G. Rates of rates of urinary tract injury from gynecologic surgery and the role of intraoperative cystoscopyf. Obstet Gynecol. 2006;107(6):1366-72. Ostrzenski A, Radolinski B, Ostrzenska KM. A Review of Laparoscopic Ureteral Injury in Pelvic Surgery. Obstet Gynecol Surv. 2003;58(12):794-99. Teeluckdharry B, Gilmour D, Flowerdew G. Urinary tract injury at benign gynecologic surgery and the role of cystoscopy. Obstet Gynecol. 2015;126(6):1161-9. Jacob GP, Vilos GA, Al Turki F, Bhangav G, Abu-Rafea B, Vilos AG, et al. Ureteric injury during gynaecological surgery - lessons from 20 cases in Canada. Facts, views Vis Ob Gyn. 2020;12(1):31-42. Baggish MS, Clark J, Firestein S. Thermal ureteral injury secondary to use of the ligasure device during subtotal abdominal hysterectomy. J Gynecol Surg 2005;21:(2):21:81. Sutton PA, Awad S, Perkins AC, Lobo DN. Comparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic ScalpelTM and the LigasureTM. Br J Surg. 2010;97(3):428-33. Manoucheri E, Cohen SL, Sandberg EM, Kibel AS, Einarsson J. Ureteral injury in laparoscopic gynecologic surgery. Rev Obstet Gynecol. 2012;5(2):106-11. Kilinc E, Akpak YK. A rare case of unrecognized and uncommon bladder perforation after transobturator tape procedure. Case Rep Med. 2015;2015:3-5. Chi AM, Curran DS, Morgan DM, Fenner DE, Swenson CW. Universal cystoscopy after benign hysterectomy: examining the effects of an institutional policy. Obstet Gynecol. 2017;127(2):369-75. Vanderpuye V. Renal sonography in the diagnosis of renal obstruction or hydronephrosis in patients with cervical cancer. J Clin Ultrasound. 2002;30(7):424-7. Suprasert P, Euathrongchit J, Suriyachai P, Srisomboon J. Hydronephrosis after radical hysterectomy: A prospective study. Asian Pacific J Cancer Prev. 2009;10(3):375-8. Karadeniz T, Topsakal M, Eksioglu A, Ariman A, Basak D. Renal hemodynamics in patients with obstructive uropathy evaluated by color Doppler sonography. Eur Urol. 1996;29(3):298-301. Kitrey ND, Djakovic N, Gonsalves M, Kuehhas FE, Lumen N, Serafetinidis E, et al. Urological trauma EAU Guidelines on. J Summert Guidel Assoc P-J. Published online 2016. Morey AF, Brandes S, Dugi DD. Urotrauma: AUA guideline. J Urol. 2014;192(2):327-35.. Smith AP, Bazinet A, Liberman D. Iatrogenic ureteral injury after gynecological surgery. Can Urol Assoc J. 2019;113(6):S51-5. Witters S, Cornelissen M, Vereecken R. Iatrogenic ureteral injury: Aggressive or conservative treatment. Obstet Gynecol Surv. 1987;42(4):264-5. Elliott SP, McAninch JW. Ureteral injuries: External and iatrogenic. Urol Clin North Am. 2006;33(1):55-66. McQuitty DA, Boone TB, Preminger GM. Lower Pole Calicostomy for the Management of Iatrogenic Ureteropelvic Junction Obstruction. J Urol. 1995;153(1):142-5. Lee Z, Keehn AY, Sterling ME, Metro MJ, Eun DD. A Review of Buccal Mucosa Graft Ureteroplasty. Curr Urol Rep. 2018;19(4):1-6.

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