Iatrogenic injuries to the ureter during gynecologic and obstetric operations

Iatrogenic injuries to the ureter are hazardous complications of pelvic and vaginal operations, causing severe morbidity and even mortality. Eighteen such instances that occurred during the last 30 years are analyzed. Most of the injuries were associated with attempts to achieve hemostasis without proper identification of the ureter. The incidence of ureteral injuries declined during the years concomitantly with the improvement of surgical techniques. The proper identification and, when necessary, isolation of the ureter during operations in which there is a risk is crucial in reducing the incidence of ureteral injuries. Those diagnosed at the time of injury and treated with end to end anastomosis had the best results. Delayed diagnosis and treatment were associated with poor end results. The English literature is reviewed.