The risk of ureteric injury associated with hysterectomy: a 10-year retrospective cohort study

OBJECTIVE: To evaluate the rates of ureteric injury among women undergoing hysterectomy. DESIGN: Retrospective cohort. SETTING: English National Health Service hospitals. POPULATION: Women undergoing hysterectomy in 2001-2010. METHODS: Unadjusted rates of ureteric injury, within 1 year of hysterectomy, calculated by indication and type of procedure. Multivariable logistic regression used to assess the risk of ureteric injury with year of surgery. MAIN OUTCOME MEASURES: Ureteric injury within a year of the hysterectomy. RESULTS: In 2001-2010, 377 073 women underwent hysterectomy, of whom 1792 (0.5%) experienced a ureteric injury. In both benign and malignant groups the rate of injury was higher in 2006-2010 than 2001-2005. After 2006, ureteric injuries were most common for abdominal radical hysterectomy for uterine cancer (10.7%; 95% CI 7.3-15.1%). The proportion of women having a ureteric injury was similar for ovarian and cervical cancer (1.9-4.0% depending on type of procedure). For benign conditions, the rate of injury tended to be lower, typically <1%. Women with endometriosis had the highest risk among this group (1.7% following total abdominal hysterectomy; 95% CI 1.4-2.0%). CONCLUSION: The risk of ureteric injury within 1 year of hysterectomy varied by type of hysterectomy for benign and malignant conditions. The rates of injury have increased between 2001 and 2010. TWEETABLE ABSTRACT: Ten-year study shows ureteric injury rates have increased.