EC Gynaecology

Gynecological surgeries are associated with injuries to adjacent structures within the pelvis. The ureters can be injured during gynecological surgeries like hysterectomy, myomectomy, ovarian cystectomy, ovariectomy and debulking surgeries in malignant conditions. Other adjacent structures that are commonly injured are the bladder, rectum and the intestines.

The ureters can accidentally be traumatized during surgical procedures like total abdominal hysterectomy because of their anatomical proximity to the uterus, cervix, fallopian tubes and ovaries. About 1% of gynecological surgeries are associated with ureteric injuries. They are less common than injuries to the bladder or rectum. Injury to the ureters are far more serious and troublesome. When the injury is unrecognized, there is often associated significant morbidity.

Ureteric injuries are a cause of litigation against doctors, especially in developed countries. This occurs when the injury is not detected early. Repair of a damaged ureter is technically demanding and troublesome. A urologist is needed to do the repair.

This was the case of a 49 years old nurse, para 3, two previous cesarean sections, who had a total abdominal hysterectomy for symptomatic uterine fibroid. There was associated iatrogenic injury to both ureters. This was due to adhesions in the pelvis from previous surgeries, which distorted the course of the ureters.

Prompt recognition of the injury was made by the urologist. A re-laparotomy was done, stents were inserted to connect the proximal portion of the ureters to her urinary bladder. The bladder was on continuous catheterization. After six weeks, the stents were removed and she was discharged home in good clinical condition.

The aim of this case report is to highlight the risk factors associated with ureteric injuries during gynecological surgeries and need for prompt intervention.

 Keywords: Ureteric Injury; Gynecological Surgeries; Hysterectomy; Stents

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