Iatrogenic ureteral injuries: A 20-year experience in treating 165 injuries

Purpose: We reviewed the causes, treatment and morbidity associated with iatrogenic ureteral injuries. Materials and Methods: From 1972 to 1992 the charts of all patients with the diagnosis of iatrogenic ureteral injury were reviewed and 156 with 165 injuries were identified. Results: Urological, gynecological and general surgical procedures accounted for 70 (42%), 56 (34%) and 39 (24%) injuries, respectively. Of the injuries 91% occurred in the lower third, 7% in the middle third and 2% in the upper third of the ureter, respectively. Among the urological lesions 77% were identified at injury compared to only 33% of the nonurological cases. Nonurological and urological ureteral injuries detected postoperatively required 1.8 and 1.6 procedures, respectively, compared to only 1.2 procedures in both groups (p <0.0006 and p <0.013) when the injuries were detected immediately at operation. Conclusions: Endourological procedures are the most common cause of iatrogenic ureteral injuries. When identified at injury and treated properly such injuries seldom lead to loss of renal function.