The most reliable way for surgeons to avoid ureteral injury is to clearly identify the ureter throughout the region of the body that will undergo the operation.įor pelvic operations expected to be difficult, or for patients with large pelvic masses, pelvic inflammatory disease, prior pelvic surgery or prior irradiation, the use of preoperative ureteral radiographic imaging by intravenous urography (IVU) or computed tomography (CT) has been widely advocated. (8-10) Risk Factors and Prevention of Ureteral Injury Prevention Other gynecological procedures that can result in ureteral injury are abdominal oophorectomy (removal of an ovary), pelvic mass resection, removal of a fallopian tube, caesarian section, adnexectomy (removal of one of the uterine tubes and an ovary), extended pelvic lymphadenectomy (removal of lymph nodes) and laparoscopy (a minimally invasive method used to examine the interior of the body or to perform surgery). (7) Similarly, in pregnancy, the ureters are dilated, exposure is difficult and the risks are increased. Prolapse patients can have extremely dilated and thin ureters that can be enclosed in the prolapse and, thus, be predisposed to potential ureteral injury. The majority of ureteral injuries here are during vaginal vault reconstruction or vaginal cuff closure, where sutures can ligate (be tied to) the ureter or kink the ureter by displacing it. Repair of high-grade pelvic prolapse (that is, grade 4 cystocele or total uterine prolapse) pose a particular risk for ureteral injury. The ureter can be injured during any anterior vaginal wall surgery that extends to the bladder neck (such as vaginal hysterectomy, bladder neck suspension surgery, anterior repair of the vaginal wall, repair of an enterocele and neovagina construction). (1) All gynecologic ureteral injuries occur to the distal one third of the ureter (or in other words, the segment of ureter closest to bladder and in the pelvis). (6) Of ureteral injuries from gynecologic surgery, roughly 50 percent are from radical hysterectomy, 40 percent are from abdominal hysterectomy and less than 5 percent result from vaginal hysterectomy. (4-6) Ureteral complications from radical hysterectomy have declined over the years because of improved patient selection, limiting of surgery to mostly low-stage disease, decreased use of preoperative radiation and modifications in surgical technique that limit extreme skeletonization of the ureter. (2-4) The ureter is injured in roughly 0.5 to 2 percent of all hysterectomies and routine gynecologic pelvic operations and in 10 percent (range, 5 to 30 percent) of radical hysterectomies. Gynecologic surgery accounts for more than 50 percent of all ureteral injuries resulting from an operation, with the remaining occurring during colorectal, general, vascular and urologic surgery. Ureteral injuries are a potential complication of any open or endoscopic pelvic operation. The adult ureter is a delicate structure, about the width of a pencil, and roughly 30 cm in length. In the bladder, the urine is stored and then emptied by urination. The ureters are a pair of tubes that carry urine away from the kidneys to the bladder. However, ureteral injuries typically are not recognized immediately and have the potential to be life-threatening or to result in permanent kidney damage or removal of a kidney. Bladder injuries usually are recognized and repaired immediately, and potential complications are typically minor. Bladder injuries are the most frequent urologic injury inadvertently caused by a surgeon. Lower urinary tract injury during gynecologic surgery is relatively uncommon. Informed Consent for Telehealth Consultation.Communicate securely with your physician’s office.Urologic Trauma and Reconstruction Fellowship.2014 Summer Student Research Experiences.2013 Summer Student Research Experiences.
Planning Center for Research in Benign Urology Planning Center for Research in Benign Urology.Laparoscopic Retroperitoneal Lymph Node Dissection (RPLND).Advanced Optical Imaging Cancer Detection.Surgery for Prostate Cancer: Laparoscopic.Ureteropelvic Junction (UPJ) Obstruction in Children.Urethral Stricture Disease Urethral Stricture Disease.Reconstructive Urology Reconstructive Urology.