Iatrogenic ureteric injuries following abdomino-pelvic operations: a 10-year tertiary care hospital experience in Tanzania

World Journal of Emergency Surgery

Samson Simbila¹  Albert Kihunrwa²  Anthony N Massinde²  Phillipo L Chalya³ 

[1] Department of Urology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania;Department of Obstetrics /Gynecology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania;Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania

关键词: Tanzania;    Outcome;    Management;    Abdomino-pelvic operations;    Iatrogenic;    Ureteric injuries;   

Others  :  1137193
DOI  :  10.1186/s13017-015-0011-z

 received in 2014-12-30, accepted in 2015-02-25,  发布年份 2015

【 摘 要 】

Background

Iatrogenic ureteric injuries are rare complications of abdomino-pelvic surgery but associated with high morbidity and even mortality. There is paucity of data regarding iatrogenic ureteric injuries in Tanzania and Bugando Medical Centre in particular. This study describes our experience in the management and outcome of ureteric injuries following abdomino-pelvic operations outlining the causes, clinical presentation and outcome of management of this condition in our local setting.

Methods

This was a retrospective descriptive study of patients with iatrogenic ureteric injuries following abdomino-pelvic operations that were managed in Bugando Medical Centre between July 2004 and June 2014.

Results

A total of 164 patients (M: F = 1: 1.6) were studied. Of these, 154 (93.9%) were referred to Bugando Medical Centre having had their initial surgeries performed at other hospitals, whereas 10 (6.1%) patients sustained ureteric injuries during abdomino-pelvic surgery at Bugando Medical Centre. The median age at presentation was 36 years. The most common cause of iatrogenic ureteric injuries was total abdominal hysterectomy occurring in 69.2% of cases. The distal ureter was more frequently injured in 75.6% of cases. Suture ligation was the commonest type of injury accounting for 36.6% of patients. One hundred and sixteen (70.7%) patients had delayed diagnosis but underwent immediate repair. Ureteroneocystostomy was the most frequent reconstructive surgery performed in 58.0% of cases. Of the 164 patients, 152 (92.7%) were treated successfully. Twelve (7.3%) patients died in hospital. The main predictors of deaths were delayed presentation, deranged renal function tests on admission, missed ureteric injuries and surgical site infections (P < 0.001). The overall median length of hospital stay was 12 days. Follow up of patients was generally poor as more than half of patients were lost to follow up.

Conclusion

Total abdominal hysterectomy still accounts for most cases of iatrogenic ureteric injuries in our environment. Meticulous surgical technique as well as identification of the course of the ureter and associated anatomic locations where injury is most likely to occur is important to decrease the risk of ureteric injury. Timely recognition of ureteric injury and its management is associated with good outcome.

【 授权许可】

   
2015 Chalya et al.; licensee BioMed Central.

【 参考文献 】

• [1]Preston JM: Iatrogenic ureteric injury: common medicolegal pitfalls. BJU Int 2001, 86:313-7.
• [2]Vakili B, Chesson RR, Kyle BL, Shobeiri SA, Echols KT, Gist R, et al.: The incidence of urinary tract injury during hysterectomy: a prospective analysis based on universal cystoscopy. Am J Obstet Gynecol 2005, 192:1599-604.
• [3]Obarisiagbon EO, Olagbuji BN, Onuora VC, Oguike TC, Ande ABA: Iatrogenic urological injuries complicating obstetric and gynaecological procedures. Singapore Med J 2011, 52:738-41.
• [4]Carver BS, Bozeman CB, Venable DD: Ureteral injury due to penetrating trauma. South Med J 2004, 97:462-4.
• [5]Fraga GP, Borges GM, Mantovani M, Ferreira U, Laurito TL, Netto NR: Penetrating ureteral trauma. Int Braz J Urol 2007, 33:142-50.
• [6]Al-Awadi K, Kehinde EO, Al-Hunayan A, Al-Khayat A: Iatrogenic ureteric injuries: incidence, aetiological factors and the effect of early management on subsequent outcome. Int Urol Nephrol 2005, 37:235-41.
• [7]Geavlete P, Georgescu D, Niţă G, Mirciulescu V, Cauni V: Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience. J Endourol 2006, 20:179-85.
• [8]Liapis A, Bakas P, Giannopoulos V, Creatsas G: Ureteral injuries during gynecological surgery. Int Urogynecol J 2001, 12:391-4.
• [9]Fröber R: Surgical atlas, surgical anatomy of the ureter. BJU Int 2007, 100:949-65.
• [10]Tijani KH, Onwuzurigbo KI, Ojewola RW, Afolabi BB, Akanmu NO: Iatrogenic ureteric injuries in a Nigerian teaching hospital: experience in the last decade. East Afr Med J 2011, 88:304-9.
• [11]Mteta KA, Mbwambo J, Mvungi M: Iatrogenic ureteric and bladder injuries in obstetric and gynaecological surgeries. East Afr Med J 2006, 83:79-85.
• [12]Williams G, Broughton S, Worku H, Tekle H: Five years’ experience of ureterovaginal fistulae following obstetric or gynaecological intervention in Ethiopia. Afr J Urol 2010, 16:17-9.
• [13]Chinakwana GU, Okafor PI, Ikechebelu JI: Urology injuries following gynaecological operation – our experience in a teaching hospital in Nigeria. West Afr J Med 2006, 25:153-6.
• [14]Oboro V, Dare FO, Fadiora SO, Aderounmu AOA, Adeoti ML, Ajadi AM: Ureteric injury following pelvic operations. East Afr Med J 2002, 79:611-3.
• [15]Aronson MP, Bose TM: Urinary tract injury in pelvic surgery. Clin Obstet Gynaecol 2002, 45:428-38.
• [16]Chou MT, Wang CJ, Lien RC: Prophylactic ureteral catheterization in gynaecologic surgery: a 12-year randomized trial in a community hospital. Int Urogynecol J Pelvic Floor Dysfunct 2009, 20:689-93.
• [17]Kim J-H, Moore C, Jones JS, Rackley R, Daneshgari F, Goldman H, et al.: Management of ureteral injuries associated with vaginal surgery for pelvic organ prolapse. Int Urogynecol J 2006, 17:531-5.
• [18]Hammad FT, Alqaiwani KM, Shirodkar SS: The role of urologists in the management of urological injuries during obstetric and gynaecologic surgery. Int Urogynecol J Pelvic Floor Dysfunct 2010, 21:1237-41.
• [19]Durrani SN, Rehman A, Khan S, Ullah H, Khan MK, Ullah A: Ureteral trauma during open surgery: etiology, presentation and management. J Ayub Med Coll Abbottabad 2013, 25:86-9.
• [20]Schimpf MO, Gottenger EE, Wagner JR: Universal ureteral stent placement at hysterectomy to identify ureteral injury: a decision analysis. BJOG 2008, 115:1151-8.
• [21]Rafique M, Arif MH: Management of iatrogenic ureteric injuries associated with gynaecological surgery. Int Urol Nephrol 2002, 34:31-5.
• [22]Anwar MS, Tariq M, Saeed K, Ghafoor T, Mustafa G: Causes of ureteric injuries and outcome of different surgical procedures for the repair of ureter. J Sheikh Zayed Med Coll 2010, 1:16-20.
• [23]Matani YS, Bani-Hani KE, Bani-Hani IH: Ureteric injuries during obstetric and gynecologic procedures. Saudi Med J 2003, 24:365-8.
• [24]Mahendran HA, Singam P, Ho C, Hee TG, Zainuddin ZM: Iatrogenic ureter injuries: eleven years experience in a tertiary hospital. Med J Malaysia 2012, 67:169-72.
• [25]Brandes S, Micheal C, Noel A, Jackmcaninch : Diagnosis and management of ureteric injury: an evidence-based analysis. BJU Int 2004, 94:277-89.
• [26]Visco AG, Taber KH, Weidner AC, Barber MD, Myers ER: Cost-effectiveness of universal cystoscopy to identify ureteral injury at hysterectomy. Obstet Gynecol 2001, 97:685-92.
• [27]Routh JC, Tollefson MK, Ashley RA, Husmann DA: Iatrogenic ureteral injury: can adult repair techniques be used on children? J Pediatr Urol 2009, 5:53-5.
• [28]Mensah J, Klufio G, Ahiaku F, Osafo C, Gepi-Attee S: Delayed recognition of bilateral ureteral injury after gynaecological surgery. Ghana Med J 2008, 42:133-6.