Prediction of Periureteral Adhesions by Drop Infusion Pyelography Before Laparoscopic Hysterectomy: A Retrospective...

To identify the predictors for periureteral adhesions preoperatively.

Preoperative predictors for periureteral adhesions were evaluated in 407 patients who underwent laparoscopic hysterectomy (LH) for benign uterine diseases in our hospital between 2013 and 2022.

Periureteral adhesions were observed in 57 patients (14%). Multivariate analysis identified the following predictors for periureteral adhesions: endometriosis (odds ratio (OR), 8.54; 95% confidence interval (CI), 1.51-48.30; p < 0.05), obliteration of Douglas' pouch (OR, 89.50; 95% CI, 5.07-1580.03; p < 0.01), and ureteral flexion on drop infusion pyelography (DIP) (OR, 647.00; 95% CI, 63.00-6650.02; p < 0.001). Ureteral flexion on DIP diagnosed periureteral adhesion most accurately (sensitivity: 93.0%, specificity: 95.1%, accuracy: 94.8%). Operation time to complete LH was significantly longer in the adhesion group than in the non-adhesion group (162 min vs. 148 min; p < 0.01). Iatrogenic ureteral injury (IUI) was more common in the adhesion group than in the non-adhesion group (OR, 19.14; 95% CI, 1.51-1013.84; p < 0.01).

These results suggest that preoperative DIP is a useful predictor of periureteral adhesions. Preoperative preventive measures for IUI, such as ureteral stenting, are important in cases where severe adhesions are suspected.