Author : S. Abdul-kareem, Abdul-ghafoor
Annals of the College of Medicine, Mosul,
2006, Volume 32, Issue 1, Pages 12-17
Objective: ureteric injuries may be missed and present as a complication.Design: A case series study.Setting: Retrospective study conducted during the period from January 1998 to March 2002 in the urosurgical departments at Al-Jumhoori and Al- Salaam teaching hospitals, Mosul. Participants: Ten cases of missed ureteric injuries were consulted for or referred to the urosurgical departments, during or after their initial surgical procedures either from the general surgical or gynecological departments.Results: There were (6) males and (4) females; mean age was (25 years). Eighty percent of cases diagnosed post operatively. They were missed for variable duration from 24 hours to 2 months. Complications like urinary fistula, loin abscess, fever or loin pain were diagnosed. Two cases were diagnosed and managed intra operatively. The cause of injury was bullets in (50%) of cases, gynecological operations in (30%) and RTA in (20%). Lower parts of the ureter was involved more frequently (60%) specially in pelvic surgery, while the whole ureter was involved by missiles. Both sides were equally implicated. Missed or improperly treated ureteric injury carries high morbidity like hospital stay, re-exploration (70%) and loosing renal unit function. Uretero- common iliac artery fistula is a rare but serious complication reported in one of the cases.Conclusion: Sound knowledge of pelvic anatomy, preoperative ureteric stenting, isolated uterine artery ligation, keeping the ureteric injury in mind and deliberate ureteric identification during shell injuries decrease the chance of missed ones and their sequelae.