Prediction of Periureteral Adhesions by Drop Infusion Pyelography Before Laparoscopic Hysterectomy: A Retrospective Study

Azuma Y; Yukihiro Azuma; Fujioka R; Rina Fujioka; Koji Yamamoto; Yamamoto K; Mei Matsumoto; Matsumoto M; Hiroki Nagata; Nagata H; Ikumi Wada; Wada I; Maako Moriyama; Moriyama M; Hiroaki Komatsu; Taniguchi F; Fuminori Taniguchi

doi:10.1111/jog.70141

Prediction of Periureteral Adhesions by Drop Infusion Pyelography Before Laparoscopic Hysterectomy: A Retrospective Study

Azuma Y, Yukihiro Azuma, Fujioka R, Rina Fujioka, Koji Yamamoto, Yamamoto K, Mei Matsumoto, Matsumoto M, Hiroki Nagata, Nagata H, Ikumi Wada, Wada I, Maako Moriyama, Moriyama M, Hiroaki Komatsu, Taniguchi F, Fuminori Taniguchi

Journal of Obstetrics and Gynaecology Research · 2025 · vol. 51(11) , pp. e70141 · doi:10.1111/jog.70141 · PMID:41242707

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This study identified endometriosis, Douglas' pouch obliteration, and ureteral flexion on drop infusion pyelography as predictors of periureteral adhesions, with ureteral flexion being the most accurate indicator.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-12 · read from full text ⓘ

This retrospective study evaluated preoperative predictors of periureteral adhesions in 407 patients undergoing laparoscopic hysterectomy for benign uterine diseases (2013–2022). Periureteral adhesions were found in 57 patients (14%), and multivariate analysis identified endometriosis, obliteration of Douglas’ pouch, and ureteral flexion on drop infusion pyelography (DIP) as significant predictors; ureteral flexion on DIP had sensitivity 93.0%, specificity 95.1%, and accuracy 94.8% for diagnosing adhesions. Patients with adhesions had longer operation times and higher odds of iatrogenic ureteral injury. The paper’s limitation is its retrospective design and data sharing restrictions. Relevance to endometriosis: endometriosis was identified as an independent, strong predictor of periureteral adhesions in this preoperative prediction study, though the focus is on periureteral adhesion prediction before laparoscopic hysterectomy.

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Abstract

AIM: To identify the predictors for periureteral adhesions preoperatively. METHODS: Preoperative 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. RESULTS: Periureteral 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). CONCLUSION: These 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.

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Abstract

Aim To identify the predictors for periureteral adhesions preoperatively.

Methods

Preoperative 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.

Results

Periureteral 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).

Conclusion

These 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. Disclosure An 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. Conflicts of Interest Dr. 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. Data Availability Statement Data 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.

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Condition tags

endometriosis

MeSH descriptors

Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy Hysterectomy

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