Incidence and management of gynaecological-related ureteric injuries

We report a 5-year review of all ureteric injuries at a major Sydney teaching hospital as a result of gynecological procedures. A retrospective analysis was made of all hospital medical records and consultant follow-up notes from January,1990 to May, 1995. Injuries were recorded in 22 patients with a mean age 52 years (range 31-88). Of these, 17 occurred at our institution, while 5 were referred from peripheral hospitals. Two injuries were bilateral, and 6 were discovered intraoperatively. Patients were managed acutely where possible. Treatment options included cystoscopy and retrograde stenting, deligation, neoureterocystostomy, transureteroureterostomy or nephrectomy. Follow-up imaging was available in 16 patients, of those, 15 were normal, and 1 showed bilateral obstruction secondary to radiotherapy. The overall risk of ureteric injury for all methods of hysterectomy was 0.44% (0.24% for total abdominal hysterectomy).