Obstetric and gynaecological ureteric injuries: treatment and results

OBJECTIVE: To compare endourological techniques and open surgery in the treatment of ureteric injuries following obstetric and gynaecological surgery. PATIENTS AND METHODS: From January 1982 to February 1994, 63 women (mean age 51 years, range 22-70) were treated for 72 ureteric lesions consequent upon obstetric or gynaecological surgery. In nine patients, 10 ureteric lesions were detected intra-operatively and repaired immediately. In the remaining 54 patients, the 62 ureteric injuries were diagnosed and treated after a delay; 29 patients with 37 ureteric injuries underwent repair by open surgery while 25 patients with a unilateral ureteric lesion underwent elective primary endourological treatment. RESULTS: The results of repair were not related to the type of treatment; the cure rate was 87, 88 and 90% for delayed open surgical, endourological and immediate intra-operative repair, respectively. The site (vesico-ureteric junction, uterine artery or infundibulopelvic ligament) and the type (fistula or stenosis) of ureteric lesion had no influence on the results, regardless of the type of treatment. The results of ureteric repair were related to the surgery that caused the lesion; 88% of the poor results occurred in the patients who underwent radical hysterectomy alone or combined with radiotherapy and approximately half of the irradiated patients required major surgery. CONCLUSION: When the patients are correctly selected, endourological treatment plays an equally important role in the treatment of gynaecologically-related ureteric injuries when compared to open surgery. Special attention should be paid to the treatment of lesions caused by radical hysterectomy alone or associated with radiotherapy, as these may lead to poor results.