Diagnosis of ureteral obstruction during complex urogynecologic surgery

Intraoperative cystoscopy has been recommended to identify unsuspected bladder and ureteral injuries resulting from gynecologic surgery. We retrospectively reviewed 157 cases of complex urogynecologic procedures at our institution. Intraoperative cystoscopy revealed no bladder injuries. Five cases of unsuspected ureteral obstruction were identified (3.2%). One case of ureteral ligation was diagnosed and repaired intraoperatively. The remaining 4 cases were found to represent chronic ureteral obstruction resulting from pelvic organ prolapse (2 cases), ureteropelvic junction obstruction (1 case) and stenosis of the ureterovesical junction after transurethral resection (1 case). Intraoperative assessment required an average of 90 minutes. Our experience suggests that pre-existing ureteral obstruction may be more common than intraoperative injury. In selected populations, routine preoperative assessment of the ureters is indicated to simplify intraoperative evaluation.