[Treatment of ureteral lesions during gynecologic surgery].
Surgery of gynecologic area and of pelvic cavity in general is a risk situation for ureteral injury. The incidence of these injuries is about 1% and may be considered as "unavoidable", irrespective of the surgical approach which could be either abdominal, vaginal or laparoscopic. In this study, 37 patients who had undergone a previous gynecological surgery were assessed for 38 ureteral units. Ureteral injury was identified at the surgical table in 2 patients who were treated successfully during the same surgical session with an end-to-end anastomosis. In 8 patients, a double-J ureteral stent was placed and the cure was obtained in 7 patients. The single case of failure was converted to surgery. 22 female patients for 23 ureteral units were subjected to open surgery performing 16 ureterocystoneostomies, 6 of them with a combined psoas-bladder hitching. In 1 patient a termino-terminal anastomosis was performed due to an injury in an upper site. Finally, in 3 patients nephrectomy was carried out due to a nonfunctional kidney; 1 patient refused surgery, whereas in another patient a spontaneous canalization of the excretory tract was obtained after reposition of a percutaneous nephrostomy. The minimum follow-up is of at least 1 year. The diagnostic aspects and therapeutic indications are then described with a special emphasis on the so-called prognostic factors which could influence the outcome of the treatment. Finally, the main surgical correction techniques employed in case of leakage of ureteral substance, are reviewed.
Ranieri
Antonio
A
U.O. di Urologia, Ospedali Riuniti, Bergamo.
Sironi
Dario
D
Micheli
Emanuele
E
Zambolin
Tiziano
T
Spaliviero
Massimo
M
Cunico
Sergio Cosciani
SC
Lembo
Antonino
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D009392:Nephrectomy; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000000981:diagnostic imaging / Q000293:injuries*; D014547:Urinary Diversion; D014548:Urinary Fistula / Q000209:etiology; D014567:Urography
Il trattamento delle lesioni ureterali in corso di chirurgia ginecologica.