Early Recognition and Minimally Invasive Management of Ureteral Injury after Total Hysterectomy
2Department of Gynecology, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fujian
3Department of Gynecology, Zhangpu County Traditional Chinese Medicine Hospital, Zhangzhou
4School Of Clinical Medicine, Fujian Medical University, Fuzhou
Aim: To estimate the early detection and effective interventions for iatrogenic ureteral injuries after hysterectomy.
Patients and methods: This was a multicentre retrospective study of patients presenting with iatrogenic ureteral injuries after total hysterectomy in our hospital from October 2013 to December 2021. The study information was obtained from our electronic clinical system, and the clinical features included age, type of gynaecologic disease, primary surgery, time of diagnosis of ureteral injury, therapy for injury and outcome.
Results
A total of 22 patients presenting with ureteral injury after total hysterectomy were included in this study. The mean age was 48 years, the mean time of diagnosis was 12 days, 7 of the cases (31.8%) were found intraoperatively, and 15 of them (68.2%) were found postoperatively. The types of disease causing the injury were benign gynaecological diseases in 14 of the patients (63.6%) and malignant diseases in 8 of the patients (36.4%). The primary treatment was ureteral stenting and successfully performed in 8 patients (36.4%), with 14 failure cases. One failure patient was confirmed to have a ureterovaginal fistula on the twelfth day after hysterectomy due to suture, and the fistula was treated by laparoscopic vesicoureteral reimplantation three months later. Most importantly, in one case, the patient had the same cause of ureteral injury as the patient in the failure case, the ureteral injury was found through surgical video recording, and it was detected early on the fourth day after hysterectomy and was promptly cured by transvaginal suture removal and ureteral stenting. None of the female patients died.
Conclusion
Early dissection, ureteral stent implantation and transvaginal suture removal will provide a new minimally noninvasive treatment option for treating ureteral injuries. We initially describe a noninvasively and successfully treated case of a ureteral injury after hysterectomy, and the technique described is a novel therapy for iatrogenic ureteral injuries to obtain better outcomes.
This project was financially supported by Special Health Subsidy of Fujian Provincial Finance Department (2100206 50502 302), Health Care Youth and Middle-aged Training Project of Fujian Province (2021GGB014), And Fujian Provincial be Funds for the innovation of science and Technology (2020Y9151, 2021Y9169, 2021Y9180). Fujian Research and Training Grants for Young and Middle-aged Leaders in Healthcare.