The early recognition of ureteral injury after gynecological surgery and
the technique of endoscopic placement of ureteral stents
Abstract
Objective: To investigate the early recognition of ureteral injury in
gynecological operation and improve the technique of endoscopic
placement of ureteral stents. Design:Retrospectively analyze the
clinical and prognostic data of iatrogenic ureteral injuries in
gynecological operations in our institution from 2013 to 2019. Setting:
Shunde Hospital, Southern Medical University. Population: Women with
iatrogenic ureteral injury due to gynecological surgery. Methods: To
analyze the causes, clinical manifestations, early identification
methods and surgical techniques for repairing ureteral injuries of
patients with iatrogenic ureteral injuries. Main outcome measures:Time
to discover ureteral injury by different methods and success rate of
ureteral injury repair. Results:13 cases were delayed diagnosis, of
which 4 cases were confirmed by pelvic drainage urinary creatinine
detection at 6.50 ± 3.11 days after operation, and 9 cases were
diagnosed by pyelography after 36.8 ± 12.36 days after operation.
Ureteroscopy + retrograde ureteral stent placement were the first
choices. Seven patients (53.85%) were successful. Three patients who
failed repair operation immediately used cis-percutaneous nephroscopy
combined with retrograde ureteroscopy to successfully place ureteral
stents. Among the 10 patients who successfully placed stents, 9 patients
were cured except for 1 case of renal insufficiency. Conclusions: The
liquid creatinine test for recognition of ureteral injury after
gynecological surgery is effective.For some serious ureteral injuries,
percutaneous renal anterograde combined with retrograde ureteroscopy and
ureteral stent placement can improve the success rate of intubation.