ABSTRACT

Background: Ureteric injuries represent infrequent but devastating consequences of iatrogenic injuries during gynecological, obstetric, pelvic and urological procedures.

Aim: To evaluate the etiology, management and outcome of ureteric injuries over a three-year period in local clinical settings.

Methods: We performed a retrospective study to review the etiology, management, and treatment outcomes in patients presenting with ureteric injuries at our tertiary care single center in Pakistan. The data was analyzed for descriptive statistics using SPSS version 20.

Results: A total of 59 cases of ureteric injuries were identified over a period of three years. Most of the ureteric injuries (83%, 49/59) resulted in the development of ureterovaginal fistula. Among these, around 14% (8/59) cases of ureterovaginal fistula also had other concomitant fistulae, while ureterocutaneous fistula only was seen in another 3% (02/59) of patients. The main etiological factor associated with ureteric injury and subsequent ureterovaginal fistula formation was gynecological procedures (56%, 33/59) followed by obstetric surgeries (32%, 19/59) in our case series. Most frequently, ureteral reimplantation with ureteral stenting (54%, 32/59) and Boari flap reconstruction (27%, 16/59) were used to repair ureterovaginal fistula in our study. While, ureteral stenting alone in repairing ureterovaginal fistula was possible in only 5% (03/59) cases. The overall success rate of ureteric injury repair was 95% (56/59 cases).

Conclusions: Ureteric injuries resulting in ureterovaginal fistula formation are not uncommon after gynecological and obstetric surgeries. Early diagnosis and intervention with surgical approach produces excellent results.