MANAGEMENT OF LATE IATROGENIC URETERAL INJURIES AFTER OPEN PELVIC SURGERIES: A 10 –YEAR EXPERIENCE IN GHAEM HOSPITAL, MASHHAD

Introduction:Despite of growing developments in surgical techniques, ureteral injuries are still a potential complication relating to general surgery, urology and gynecology. This study aims to evaluate the symptoms, etiology, diagnosis and management of non-endourologic iatrogenic uretral injuries. Methods: This study was retrospectively performed on female patients with of non-endourologic uretal injuries who were referring to Ghaem hospital, Mashhad between 1997 and2007. In this study, the type of their previous operation (which had caused the injury), diagnostic approach, treatment modality and outcomes were evaluated. The total number of 17 patients were studied (including 20 solitary uretral injuries). Results: The age of patients were between 26-67 years old (mean 43.14 yr). Patients’ symptoms included flank pain in 88.23, true incontinence in 41.17, fever in 29.41, anuria in 11.76, illeus and abdominal distension in 11.76, prolonged nausea in 5.88 and acute abdomen in 5.88. Previous surgeries which caused ureteral injuries were gynecologic procedures in 15 patients (88.23), including hysterectomy in 8 patients (47.05) and caesarian section in 4 cases (23.52), Wertheim surgery, resection of ovarian cyst and pelvic endometriosis surgery 1 case in each (5.88). In 2 cases the injuries were occurred during non-gynecologic surgeries. Modified lich re-implantation was performed in 11 lower injuries of ureter. In one case the anastomosis were performed with Politano-Ledbetter method. Boari flap technique was used for repair of two lower injuries of ureter. Left to right trans-uretro-uretrostomy (TTU) was performed in one case. Also one case with middle uretral injury was treated with uretro-uretrostomy. Auto-transplantation was applied in one case with upper injury. Conclusion: In our cases, the most common cause of iatrogenic ureteral injury was simple hysterectomy and the most common presented symptoms were flank pain and true incontinence. Most of the patients needed relevant surgeries particularly uretroneocystostomy. In upper injuries the minimally invasive techniques instead of nephrectomy or Auto-transplantation should be considered.