The detection of ureteral injuries after hysterectomy.
OBJECTIVE
To identify the incidence and outcomes of ureteral injuries in patients undergoing hysterectomy, and to evaluate the effect of intraoperative cystoscopy and early postoperative ureteral jet ultrasonography.


METHODS
Retrospective comparative study (Canadian Task Force classification II-2).


METHODS
Tertiary medical center.


METHODS
Fifteen patients who experienced ureteral injuries while undergoing hysterectomy out of 4950 total patients during a 6-year period.


METHODS
All patients underwent hysterectomy, and intraoperative cystoscopy or early postoperative ureteral jet ultrasonography were used to evaluate ureteral integrity.


RESULTS
The incidence of ureteral injury recognized after hysterectomy was 0.32%, and all ureteral injuries occurred during laparoscopic hysterectomy. The initial detection of ureteral injury resulted from intraoperative cystoscopy in five patients, early postoperative ureteral jet ultrasonography in two patients, and signs and symptoms in eight patients. The patients whose injuries were detected by either intraoperative cystoscopy or early postoperative ureteral jet ultrasonography were diagnosed earlier (1.7 and 19.9 postoperative days, respectively; p<.01) and tended toward more conservative treatment (p=.119; OR=10; 95% CI 0.78-128.78) than those who were diagnosed based on signs and symptoms alone.


CONCLUSIONS
Use of intraoperative cystoscopy or early postoperative ureteral jet ultrasonography leads to earlier diagnosis of posthysterectomy ureteral injury, thereby allowing for more conservative treatment.
Wu
Hsin-Hung
HH
Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, and College of Health Sciences, Institute of Medical Research, Chang Jung Christian University, Tainan, Taiwan. 58436@cch.org.tw
Yang
Pei-Yin
PY
Yeh
Guang-Perng
GP
Chou
Pan-Hsin
PH
Hsu
Jui-Chang
JC
Lin
Kuo-Cherng
KC
D000328:Adult; D003558:Cystoscopy; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007430:Intraoperative Care; D008875:Middle Aged; D011182:Postoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014513:Ureter / Q000293:injuries*; D014515:Ureteral Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy