[Early detection of ureteral injuries associated with hysterectomy. A prospective echographic study]

Among ureteral injuries that occur during hysterectomy some are neglected and remain asymptomatic. They occur even, although not particularly, during so-called easy operations. Their severity and their need for early treatment point to the use of effective screening. It is not possible to carry out intravenous urography routinely. Searching, however, for pyelo-calyceal dilatation by ultrasound of the kidneys can show ureterohydronephrosis and can detect ureteral trauma. The authors carried out such ultrasound controls in 150 consecutive patients the day before, and the fourth and ninth days after hysterectomy. On the fourth day pyelo-calyceal dilatation is seen more frequently but is not large. Large dilatation appearing on the fourth postoperative day may be considered an early and reliable sign of suspect injury. The authors suggest that renal ultrasound should be carried out routinely on the day before and the fourth day after hysterectomy. The authors feel that when dilatation of the pyelo-calyceal area increases by 12 mm or more between the two examinations major ureteral injury must be suspected and urography carried out intravenously.