Surgery for ureteral repair after gynaecological procedures: a single tertiary centre experience

This study evaluates the frequency of ureteral repair and its management in patients with a history of gynaecologic surgery. After retrospective review of the medical records of all major gynaecologic operations performed over a six-year period (2004-2010), 17 cases of ureteral repair were identified. The indication and the type of gynaecological surgery, the anatomic site, the indication, the type of ureteral repair and the associated morbidity were analyzed. Ureteral repair was necessary in 17 (0.26 %) out of 6,422 patients who had undergone a gynaecological operation. The indication for surgery was fibroma in 6 cases (0.11 %) out of 5,481 and malignancy in 11 cases (1.17 %) out of 941. Ureteral damage was recognized intraoperatively in eight patients and postoperatively in nine with a mean delay of 13.1 days (range 1-29). Indications for ureteral repair were ligation (11.8 %), laceration (11.8 %), partial or total accidental transection (29.5 %), metastasectomy due to tumor infiltration (17.4 %) and fistula formation (29.5 %). Ureteral repair was accomplished by ureteroneocystostomy (70.6 %), ureteroureterostomy (5.9 %), insertion of a double-j stent (17.6 %) and Boari-Ockerblad flap (5.9 %). Febrile morbidity was the most common postoperative symptom (29.0 %), followed by wound infection (18 %) and ileus (1 %). One patient (5.9 %) developed hydronephrosis due to ureteric stenosis as a late complication. Although the need for ureteral repair is relatively infrequent during gynaecological operations, prompt recognition and treatment within accepted guidelines result in successful outcome.