Changing incidence and etiology of iatrogenic ureteral injuries

In the last decade there have been major advances in endoscopic surgery including ureteroscopy and laparoscopy, both of which may cause ureteral injury. We sought to determine if increased use of these procedures affected the frequency and nature of major iatrogenic ureteral injuries managed at our medical center. From 1980 to 1984 we treated 8 patients with such injuries compared to 19 patients treated from 1985 to 1989. The most recent period corresponded to the institution of ureteroscopy and the use of more aggressive laparoscopic procedures. Of the patients 14 sustained injuries at our center while 13 were referred from other institutions. Between 1985 and 1989 the incidence of injuries per total hospital admissions at risk increased from 4 to 11 per 10,000 (p = 0.0067), the incidence of urological injuries increased from 4 to 23 per 10,000 (p = 0.0071) and the incidence of injuries occurring in gynecologic patients increased from 13 to 41 per 10,000 admissions (p = 0.0385). There was no difference in the incidence of injuries in the general surgical population. From 1980 to 1984 no laparoscopic or ureteroscopic injuries occurred. However, from 1985 to 1989, 25% of gynecologic injuries occurred during laparoscopy and 70% of urological injuries were sustained during ureteroscopic procedures. Depending on the extent of the injury, patients were initially treated with either endourological or open surgical procedures. Good results were obtained in the majority of cases. Contemporary therapeutic strategies for treating patients sustaining ureteral injuries are discussed.