title: [Ureteral injury in gynecologic laparoscopies].
abstract: OBJECTIVE
  To investigate the ureteral injury in gynecological laparoscopies and discuss its diagnosis, treatment and prevention.
  
  
  METHODS
  Ureteral injury in gynecological laparoscopies during the past 13 years was reviewed retrospectively. The clinical features of initial operations including the types of disease, uterine size, pelvic adhesion, operative procedures and the methods of diagnosis, treatment and prognosis of ureteral injury were studied.
  
  
  RESULTS
  There were 8 ureteral injuries (0.14%) in 5 541 gynecological laparoscopies with seven in laparoscopically assisted vaginal hysterectomy (LAVH)/total laparoscopic hysterectomy (TLH) (0.45%) and one in non-LAVH (0.03%). The main gynecological disorders included adenomyosis, endometriosis and leiomyoma. All patients had pelvic adhesions and 4 had previous pelvic operations. Uterine enlargement was found in 7. Patients presented increased vaginal drainage, flank pain, increased volumes of vaginal discharge, nausea and vomiting, fever, edema, or peritonitis from 0 to 13 days postoperatively. Ureteral injuries were mainly diagnosed via excretory urogram (IVP). The sites of injury were near the inferior margin of the sacroiliac joint in two women and at the inferior part of ureter (near the uterine vessel, uterosacral ligament and ureterovesical junction) in 6. Two patients whose injuries were found soon after operation received ureteral repair by laparotomy successfully. Two of the six patients whose injuries were found several days later were treated with internal ureteral stenting successfully, the other four failed with ureteral stenting and received ureteral repair by laparotomy. Outcomes were good in all cases.
  
  
  CONCLUSIONS
  Ureteral injury is an uncommon and severe complication in gynecological laparoscopies. Symptoms like abnormally increased drainage, fever, flank pain, abnormal vaginal discharge and peritonitis after operation should be paid attention to and ureteral injury be considered. Surgical repair is the primary treatment.
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
authors.forename: Jin-song
authors.initials: JS
authors.lastname: Gao
authors.forename: Jin-hua
authors.initials: JH
authors.lastname: Leng
authors.forename: Jing-he
authors.initials: JH
authors.lastname: Lang
authors.forename: Zhu-feng
authors.initials: ZF
authors.lastname: Liu
authors.forename: Keng
authors.initials: K
authors.lastname: Shen
authors.forename: Da-wei
authors.initials: DW
authors.lastname: Sun
authors.forename: Lan
authors.initials: L
authors.lastname: Zhu
mesh_terms: D000328:Adult; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects; D007431:Intraoperative Complications / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014513:Ureter / Q000293:injuries* / Q000601:surgery; D014515:Ureteral Diseases / Q000601:surgery*