Management of bilateral ureteric injuries after gynaecological and obstetric procedures

The outcome of 24 patients affected by bilateral injuries of the ureter after gynaecological and obstetric procedures was analyzed. Five patients were not treated because they were asymptomatic, while 19 patients underwent different kinds of surgical procedures. Ureteric stenting was performed in 4 patients, reconstructive procedures in 9, internal diversions in 2 and external diversions in 4. Good results were achieved in 14 (74%) of the 19 treated patients. The success rate, however, was remarkably higher (85%) in the group of patients treated with ureteric stenting or reconstructive procedures than in those treated with diversions (50%). Ureteric stenting and bilateral reconstructive procedures, when feasible, constitute the simplest and safest way to repair short ureteric injuries. In the management of extensive injuries nephrostomy represents a safe and valid alternative to open surgical diversions which do not improve the quality of life and may even be life-threatening.