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.