[THREE CASES OF IATROGENIC URETERAL INJURY ASSOCIATED WITH TOTAL LAPAROSCOPIC HYSTERECTOMY]
Akiou Okumura1, Akihiro Morii1, Masato Kiriyama2
1Department of Urology, Kurobe City Hospital.
Summary
Iatrogenic ureteral injury can occur after total laparoscopic hysterectomy (TLH). Early diagnosis and intervention, including uretero-ureterostomy and uretero-cystoneostomy, are crucial for managing these complications.
Area of Science:
- Urology
- Gynecologic Surgery
- Minimally Invasive Surgery
Background:
- Total laparoscopic hysterectomy (TLH) is a common gynecologic procedure.
- Iatrogenic ureteral injury is a potential complication of minimally invasive gynecologic surgery.
- Prompt recognition and management are essential to prevent long-term sequelae.
Observation:
- Three cases of iatrogenic ureteral injury following TLH are presented.
- Injuries included ureteral ligation, ureteral injury with extravasation, and ureteral kinking by surgical threads.
- Presenting symptoms included renal dysfunction, hydronephrosis, abdominal fullness, and ascites.
Findings:
- Case 1: Ureteral ligation near the ureterovesical junction treated with uretero-ureterostomy.
- Case 2: Left ureteral injury with intraperitoneal urine extravasation managed by uretero-cystoneostomy.
- Case 3: Left lower ureteral kinking by threads resolved with laparoscopic thread cutting and ureteral stenting.
Implications:
- This case series highlights the diverse presentations of ureteral injury post-TLH.
- It underscores the importance of vigilant postoperative monitoring for renal dysfunction and hydronephrosis.
- Timely surgical intervention, tailored to the specific injury, can lead to successful outcomes and preserve renal function.
