IATROGENIC INJURIES TO THE DISTAL URETER DURING GYNECOLOGICAL SURGERY

Surgical injury to the ureter is an important problem that confronts t he urologist, the gynecologist and the general surgeon. The authors re port 20 cases of iatrogenic pelvic ureteral injuries (22 ureters) obse rved after gynecological surgery between January 1985 and January 1995 . The ureter was injured during ligation of the lumbo-ovarian vascular pedicle because it was inadequately protected during the operation. O pen surgery and double pigtail stent insertion using retrograde route were used for treatment. The iatrogenic ureteral injury was in 18 pati ents unilateral and in the remaining 2 patients both ureters were dama ged. As regards treatment, the authors recommend immediate repair, whe never the lesion is noticed at operation. In the post-operative period , ureteral stent or double pigtail stent insertion using balloon dilat ation or ureteroscope, may be a successful conservative treatment. If the damage is only diagnosed subsequently, they recommend a ureteroves ical implantation, using the psoas hitch bladder procedure or the Boar i-Cassati-Kuss procedure if the lesion is in the lower ureter or a tra nsuretero-ureterostomy if it is in the upper ureter.