[Surgical solutions to iatrogenic ureteral lesions in 31 cases]

To conduct a critical review of the etiological, clinical and diagnostic aspects of iatrogenic ureteral lesions caused by various surgical disciplines, primarily focused on the different therapeutical options used.

Between January 1985 and December 1995, 31 iatrogenic lesions of the ureter, 19 female and 10 male, mean age 52 years, were examined. The right ureter was involved in 19 cases and the left one in 12 (2 bilateral). The ureteral lesion resulted from gynaecological surgery in 19 cases (61%), general surgery in 6 (19%), vascular surgery in 3 (10%) and urology in 3 (10%). In 9 cases (29%) it was diagnosed during surgery: in 14 cases (45%) as a result of clinical signs and symptoms and in 8 cases (25%) casually. Surgery was the option chosen in 22 cases, while in 9 conservative treatment was followed.

Surgery solved 91% of damaged ureters, and the best results were seen in patients where lesion was repaired immediately. Conservative treatment was resolutive in all cases.

Gynaecological surgery continues to be the most frequent cause of iatrogenic lesions of the ureter. Ureteral damage in males is now increasing due to the demands from general oncologic surgery, which is usually appreciated by the surgeon which allows immediate repair. Lesions caused by gynaecologic and vascular surgery are commonly overlooked and are diagnosed post-surgically either because of their clinical manifestations or accidentally. The different surgical techniques currently available allow a successful repair of this kind of lesions. Conservative therapy is appropriate in cases that fulfil a series of basic requirements.