Objective To compare endourological techniques and open surgery in the
treatment of ureteric injuries following obstetric and gynaecological
surgery. Patients and methods From January 1982 to February 1994, 63
women (mean age 51 years, range 22-70) were treated for 72 ureteric le
sions consequent upon obstetric or gynaecological surgery. In nine pat
ients, 10 ureteric lesions were detected intra-operatively and repaire
d immediately. In the remaining 54 patients, the 62 ureteric injuries
were diagnosed and treated after a delay; 29 patients with 37 ureteric
injuries underwent repair by open surgery while 25 patients with a un
ilateral ureteric lesion underwent elective primary endourological tre
atment. Results The results of repair were not related to the type of
treatment; the cure rate was 87, 88 and 90% for delayed open surgical,
endourological and immediate intra-operative repair, respectively. Th
e site (vesico ureteric junction, uterine artery or infundibulopelvic
ligament) and the type (fistula or stenosis) of ureteric lesion had no
influence on the results, regardless of the type of treatment, The re
sults of ureteric repair were related to the surgery that caused the l
esion; 88% of the poor results occurred in the patients who underwent
radical hysterectomy alone or combined with radiotherapy and approxima
tely half of the irradiated patients required major surgery. Conclusio
n When the patients are correctly selected, endourological treatment p
lays an equally important role in the treatment of gynaecologically-re
lated ureteric injuries when compared to open surgery. Special attenti
on should be paid to the treatment of lesions caused by radical hyster
ectomy alone or associated with radiotherapy, as these map lead to poo
r results.