Surgical treatment of iatrogenic strictures and obliterations in the pelvic ureter in women

Loran O.B., Seregin A.V., Dovlatov Z.A.

Actuality of this study is related to the frequent injuries of the pelvic ureter during the obstetrics and gynecological operations and to the absence of the algorithms for surgical treatment in this case. 

Materials and methods. One hundred thirty-seven women with iatrogenic stricture or obliteration of the pelvic ureter were included in this study. Median age was 49 years (range 24-73). The problem was at the right side in 70 patients (51.1%) and at the left side in 65 patients (47.4%) with two sides affected in 2 women (1.5%). Ureter stricture was present in 113 (82.5%) women, obliteration – in 24 women (17.5%). 

Results. The following interventions were carried out: endoureterotomy – 4 cases (2.9%), ureteroureterostomy – 10 cases (7.3%), ureterocystostomy and reimplantation of the ureter using Politano-Leadbetter technique – 14 cases (10.2%), Boari ureterocystoplasty – 107 women (78.1%), and nephrectomy due to function loss – in 2 cases (1.5%). Median follow-up was 60 months (range 12-118 months). All cases were recurrence-free with improve in renal function according to the dynamic renal scintigraphy. 

Conclusions. Early diagnostic of ureteral injury, drainage of upper tract, extensive surgical experience and proper selection of technique concerning the individual features are crucial for good outcomes. 

AttachmentSize
Download159.18 KB
ureteral stricture, ureter obliteration, pelvic ureter, iatrogenic ureteral injuries