title: Surgery for ureteral repair after gynaecological procedures: a single tertiary centre experience.
abstract: OBJECTIVE
  This study evaluates the frequency of ureteral repair and its management in patients with a history of gynaecologic surgery.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Although the need for ureteral repair is relatively infrequent during gynaecological operations, prompt recognition and treatment within accepted guidelines result in successful outcome.
authors.affiliation: First Department of Obstetrics and Gynaecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, D. Gounari 8 str, 54621, Thessaloniki, Greece.
authors.forename: Alexios
authors.initials: A
authors.lastname: Papanikolaou
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tsolakidis
authors.forename: Vasilios
authors.initials: V
authors.lastname: Theodoulidis
authors.forename: Evangelos
authors.initials: E
authors.lastname: Ioannidis
authors.forename: Anastasia
authors.initials: A
authors.lastname: Vatopoulou
authors.forename: Diamantis
authors.initials: D
authors.lastname: Kellartzis
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005334:Fever; D005833:Genital Neoplasms, Female / Q000601:surgery; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013530:Surgical Wound Infection; D014513:Ureter / Q000293:injuries* / Q000601:surgery*; D014552:Urinary Tract Infections; D013520:Urologic Surgical Procedures