Objective: To describe clinical presentation, etiology, and treatment of ur
eteral injuries recognized late in women who had gynecologic laparoscopies.
Methods: We reviewed the charts of 12 women who had delayed recognition of
ureteral injuries between January 1991 and December 1998.
Results: Patients presented with fever, hematuria, flank pain, or peritonit
is between 3 and 33 days postoperatively. The mechanism of ureteral injurie
s was electrocoagulation in seven women, laser ablation in one, and stapler
ligation in four. The sites of injury were near the inferior margin of the
sacroiliac joint on excretory urogram in eight women and near the ureterov
esical junction in four. Three women initially treated with internal ureter
al stents were subsequently treated with ureteroneocystostomy because of pr
ogression of urinary ascites in two and a delayed ureteral stricture in one
. In nine patients, attempts at ureteral stenting were unsuccessful and imm
ediate ureteral reconstruction was done. Outcomes were good in all cases.
Conclusion: Delayed recognition of ureteral injury after gynecologic laparo
scopy was associated with serious complications, and initial treatment with
ureteral stenting was not useful. We advocate early open repair for those
injuries. (Obstet Gynecol 2000;95:337-9. (C) 2000 by The American College o
f Obstetricians and Gynecologists.).