Diagnosis and treatment of iatrogenic lesions of the ureter in patients undergoing pelvic surgery in Yaoundé, a 10-year multi-institutional review

Abstract

<title>Abstract</title> Background Most ureteral lesions are iatrogenic, secondary to operative trauma. Iatrogenic ureteral lesions result from abdominopelvic surgery. The challenge is to diagnose them as early as possible so as to provide appropriate ureteral reconstruction early. The aim of this study was to summarize the etiologies, clinical features and general management of iatrogenic ureteral injury in a resource limited context of a low-income country. Patients and methods We carried out a multicentric study and reviewed all patients with iatrogenic ureteral lesions in three referral hospitals in Yaoundé, Cameroon, over a ten-year period. Results Overall, we recorded 52 cases of iatrogenic ureteral injuries out of 19053 pelvic surgeries performed during the study period, giving a rate of 0.27%. We finally included 38 cases. The average number of iatrogenic ureter lesions per year was 3.45 cases. The mean age was 46 ± 10.7 years, all female. Hysterectomy was responsible for 29 (76.3%) of the ureteral injuries. The majority, 34 of the 38 (89.47%) cases, were diagnosed post-operatively. The most frequent symptoms were flank pain and vaginal urine leakage in 18 (47.4%) and 13 (34.2%) cases respectively. The most common imaging procedure was ultrasound showing dilation of the right ureter in 21 (55.2%) cases. Ureteral injuries were found to be located mostly at the right distal segment and the mid ureter with a frequency of 30 (78%) and 8 (22%) respectively. All the patients underwent open surgical treatment including ureteroneocystostomy, uretero-ureterostomy, Boari flap reconstructions and nephrectomy. We found that 74% (n = 28) of participants had a favorable outcome and 26.3% (n = 10) developed postoperative complications. Conclusion In our setting, iatrogenic ureteral lesions are not uncommon in women undergoing pelvic surgery. In the absence of a high index of suspicion, diagnosis is delayed. Abdominal pelvic ultrasound usually shows the affected side. Ureteroneocystomy is commonly performed, with both minor and major complications.