Objective(s): To present our 10 years. experience in the management of
ureteric injuries occurring during gynecological surgery. Study design:
Seventy-six patients had a variety of injuries. In 29 cases, the
ureteric damage was diagnosed intraoperatively. Management of
early-diagnosed injuries included suturing, ligature removal, end-to-end
anastomosis, and reimplantation of the ureter. In 47 cases, the injury
was diagnosed postoperatively. Ureteric catheterization was attempted in
all cases presenting with obstruction. Catheterization failures were
managed with ureterolysis, and reimplantation. Small ureteric fistula
were managed with catheterization, and large communications with
reimplantation. Two cases with urinomas were treated with surgical
evacuation and anastomoses. Results: Management of early-diagnosed
injuries was relatively easy in most cases. Postoperatively-diagnosed
injuries were more difficult to treat. Catheterization failed in 28/44
(65.9%) ureters and surgical re-exploration was necessary. Long-term
morbidity was minimal and no relapses occurred. Conclusion(s): Early
recognition of a ureteric injury is the key to a complications-free
repair. Unrecognized injuries cause prolonged morbidity, and their
management can be difficult. Treatment of these injuries by experienced
teams may minimize longterm consequences. (C) 2002 Elsevier Science
Ireland Ltd. All rights reserved