Material and Method
We retrospectively analyzed the medical record of twenty-seven patients
who underwent surgical intervention for IUI in our centers between
January 2011 and April 2018.
Patients were classified according to the time of diagnosis and the need
for reoperation after the urologic intervention. The following
attributes were analyzed for each patient: previous surgery, cause of
gynecological surgery, gynecological surgical procedure, time of
diagnosis, urological intervention, and post-urological complication.
The IUI cases detected during gynecological surgery were called
’perioperative’ IUI, and those diagnosed late as ’postoperative’
(delayed) IUI.
The IUI type was categorized as ’cold transection’ due to surgical
dissection or ligation and ’thermal injury’ if it depended on any
energy-based surgical device. Ultracision Harmonic Scalpel® (Ethicon,
Cincinnati, OH) was used for surgical dissection and coagulation in all
patients with thermal injury.
Two surgeons performed all urologic interventions. All perioperative
diagnosed patients were followed-up by the same surgeon who performed
urological intervention. The delayed diagnosed group was presented
symptoms including vaginal serous discharge, localized urinoma, renal
colic, low urine volume, or pelvic pain.
Patients were evaluated either by contrast-enhanced computed tomography
urography or intravenous urography. A retrograde urethrography and
ureterorenoscopy (4.5 Fr, Richard Wolf, Knittlingen Germany) were
performed for the scope of the ureteral injury. An open-end 4.8 F 26 cm
double loop ureteral stent (Coloplast Vortek®) was placed with a
0.035-inch diameter hydrophilic coated guidewire (Cook RoadRunner®)
under fluoroscopy for the endoscopically treated patients. The
endoscopically treated patients were discharged the same day following
outpatient surgery.
Ureteroneocystostomy (UNC) was performed using the Lich Gregoir
technique in the open repair group. A urethral catheter was placed in
the patients of the Open repair group for one week. The open surgery
group was discharged on the second postoperative day or later when it is
appropriate. Stents were removed at postoperative sixth and 12th week
for the open surgery and endoscopic treatment groups.
All Patients were scheduled for a follow-up protocol and evaluated with
a urinalysis, renal function tests, renal ultrasound, and physical
examination bi-annually. No patients were lost to follow-up.
Histogram and the Shapiro-Wilk’s test were used to test whether
variables were normally distributed or not. Descriptive analyses were
presented using the mean±standard deviation or median (Interquartile
range [IQR]). The chi-square test was used to compare categories,
and the t-test was used for continuous variables. All analyses were
performed using STATA 14.2 (StataCorp, TX). Statistical significance was
set at 0.05, and all tests were two-tailed.