Diagnosis and management of 365 ureteric injuries following obstetric and gynecologic surgery in resource-limited settings.

Diagnosis and management of 365 ureteric injuries following obstetric and gynecologic surgery in resource-limited settings.

JournalInternational urogynecology journal
Publication date – Sep – 2018
Authors – Raassen, TJIP; Ngongo, CJ; Mahendeka, MM
KeywordsAbdominal ureter reimplantation, Ureteric injury, Ureterovaginal fistula
Open access – Yes
SpecialityObstetrics and Gynaecology, Urology surgery
World region Central Asia, Eastern Africa, South-eastern Asia, Southern Africa, Southern Asia
Country: Afghanistan, Bangladesh, Ethiopia, Kenya, Malawi, Rwanda, Somalia, South Sudan, Tanzania, Uganda, Zambia
Language – English
Submitted to the One Surgery Index on October 5, 2018 at 12:00 am
Abstract:

Ureteric injuries are among the most serious complications of pelvic surgery. The incidence in low-resource settings is not well documented.This retrospective review analyzes a cohort of 365 ureteric injuries with ureterovaginal fistulas in 353 women following obstetric and gynecologic operations in 11 countries in Africa and Asia, all low-resource settings. The patients with ureteric injury were stratified into three groups according to the initial surgery: (a) obstetric operations, (b) gynecologic operations, and (c) vesicovaginal fistula (VVF) repairs.The 365 ureteric injuries in this series comprise 246 (67.4%) after obstetric procedures, 65 (17.8%) after gynecologic procedures, and 54 (14.8%) after repair of obstetric fistulas. Demographic characteristics show clear differences between women with iatrogenic injuries and women with obstetric fistulas. The study describes abdominal ureter reimplantation and other treatment procedures. Overall surgical results were good: 92.9% of women were cured (326/351), 5.4% were healed with some residual incontinence (19/351), and six failed (1.7%).Ureteric injuries after obstetric and gynecologic operations are not uncommon. Unlike in high-resource contexts, in low-resource settings obstetric procedures are most often associated with urogenital fistula. Despite resource limitations, diagnosis and treatment of ureteric injuries is possible, with good success rates. Training must emphasize optimal surgical techniques and different approaches to assisted vaginal delivery.

OSI Number – 20243
PMID – 29022054

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