[Ureteral lesions in gynecologic surgery]

Ureteral lesions during gynaecologic surgery are a serious problem, affecting morbidity even when they are diagnosed postoperatively.

742 gynaecological surgical procedures performed between 1994 and 2000 at the Manuel Fajardo University Hospital where evaluated. Eight operations were complicated with ureteral lesions (1.07%); one patient suffered double lesions, for a total of 9 lesions.

9 ureteral lesions were treated in 8 patients, 7 of them were diagnosed in the postoperative period; 5 bladder reimplantations with submucosal bladder tunnel and 2 ureteral suture repairs (end to end) were performed. Delayed lesions were 2 ureteral-vaginal fistulae treated with nephrectomy and ureteroneocystostomy into a Boary's flap respectively. In both cases diagnosis was established by combination of ultrasound, intravenous pyelogram, cystoscopy, and retrograde catheterization. In all seven patients urinary tract integrity was demonstrated postoperatively.

Lower urinary tract integrity may be damaged during gynaecologic surgery, being bladder ureteral reimplantation with submucosal tunnel the most frequently used repairing procedure. Operations for benign diseases had fewer lesions (0.47%) than malignant (4.8%).