Results
All cases developed during or after gynecological surgery, and the ureter was injured of its 1/3 distal segment. Of the patients, 48.15 % (n= 13/27) were diagnosed perioperatively and 51.85 % (n=14/27) had delayed diagnosis (postoperatively). The in the delayed group was 13±8.6 days (detailed demographic and clinical characteristics of the patients are summarized in Table 1).
Postoperative diagnosed patients consisted exclusively after laparoscopic surgery (p=.025) (Table 2). In the perioperative time, 85.71 % (n=6/7) of cold transection type IUI patients were diagnosed. However, patients with thermal injury to the ureter were mostly diagnosed postoperatively ( p= .021) (Table 2).
Patients who underwent minimally invasive approach in their urological interventions, 31.25% (N = 5/16) were diagnosed during gynecologic surgery and 68.75% (n = 11/16) were diagnosed postoperatively. In comparison, in patients who underwent open reconstructive surgery, these rates were observed to be 72.72 % (n = 8/11) and 27.28 % (n = 3/11) respectively (p = .034) (Table 2).
Complications after urological intervention were categorized using the Clavien-Dindo classification system (19). We detected eight grade 3b complications in patients.
In all of these eight cases, IUI was due to thermal injury (p = .046), and the first urological intervention was endoscopic double loop stenting (p = .005) (Table 3). One of these patients was diagnosed in the perioperative period, and seven in the postoperatively (p = .016) (Table 3). The ureteral stricture was developed in six of these seven patients, and a ureterovaginal fistula was seen in one ( Table 1).
Lich Gregoir ureteroneocystostomy was performed in five of these eight patients, and no postoperative complications occurred in the follow-up. Three patients with ureteral stricture did not consent to open or laparoscopic ureteral reimplantation. These patients were followed up with repetitive ureteral dilatations and double loop stents to protect the renal unit. No renal dysfunction or hydronephrosis was observed at a median follow-up of 58.5 months (IQR: 46.5-67) (Table 1).