title: Clinical Relevance and Treatment Selection of Ureteral Injury After Cesarean Section.
abstract: The aim of this case series was to report the clinical relevance and management outcomes of ureteral injuries acquired secondary to cesarean section.
  
  
  
  This was a retrospective case series from January 2007 to September 2014. Description of the patients' characteristics, diagnostic tools for investigation, management, and postoperative follow-up was conducted on postcesarean section patients who developed symptoms of urine leakage after cesarean section and necessitated secondary surgery for ureteral injury. Descriptive statistics was used for demographics and operative data.
  
  
  
  A total of 5619 cases were managed by cesarean section during the study period. Six (0.107%; 95% confidence interval [CI], 0.1069%-0.1071%) patients had ureteral injury related to the cesarean section. Of 6 cases, 3 (0.053%; 95% CI, 0.0529%-0.0531%) had ureterouterine fistula. Three cases were managed by ureteroneocystostomy, 1 by ureteroneocystostomy with Boari flap, 1 by transureteroureterostomy, and the other one by ureteral stenting via ureterocystoscopy. Three patients had immediate operation because of an acute abdomen and 3 patients had delayed operation. The left ureter was the most common site of ureteral injury (5/6). The postoperative course was uneventful for all cases.
  
  
  
  Continuous urinary leakage and acute abdominal distention associated with fluid accumulation after emergency cesarean section should be considered as "red flag" symptoms of ureteral injury and ureterouterine fistulae complications. Delayed management for ureteral repair may not be associated with bad outcomes for management of ureterouterine fistula. Delayed management was associated with less blood loss, less operating time, and acceptable outcome among patients with ureterouterine fistulae when the renal function is not compromised.
authors.affiliation: From the *Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Medical Center, Keelung; †Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Medical Center, Taipei; ‡Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan; §Chang Gung University, School of Medicine, Taoyuan; ∥Division of Urogynecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China; ¶Department of Obstetrics and Gynecology, H. Adam Malik General Hospital, North Sumatra University, Medan, Indonesia; and **Department of Obstetrics and Gynecology, De La Salle University Medical Center, Dasmariñas, Cavite, Philippines.
authors.forename: Tsia-Shu
authors.initials: TS
authors.lastname: Lo
authors.forename: Tomy
authors.initials: T
authors.lastname: Wijaya
authors.forename: Liang-Ming
authors.initials: LM
authors.lastname: Lo
authors.forename: Chuan-Chi
authors.initials: CC
authors.lastname: Kao
authors.forename: Pei-Ying
authors.initials: PY
authors.lastname: Wu
authors.forename: Eileen Feliz M
authors.initials: EF
authors.lastname: Cortes
authors.forename: Shih Yin
authors.initials: SY
authors.lastname: Huang
authors.forename: Chih Hui
authors.initials: CH
authors.lastname: Lin
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D005402:Fistula / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D049590:Postpartum Period; D012189:Retrospective Studies; D014463:Ultrasonography; D014513:Ureter / Q000293:injuries* / Q000601:surgery; D014570:Urologic Diseases / Q000175:diagnosis* / Q000601:surgery