Introduction
Ureter runs in the major pelvis over the iliac vessels and through the uterine artery; thus, it is vulnerable to iatrogenic damage in pelvic surgery (1). Owing to the rise in the total number of surgical procedures and the widespread use of minimally invasive surgical methods, the occurrence of iatrogenic ureteral injury (IUI) has increased (2, 3). Non-urologic IUI cases are often detected post gynecological surgery (4). The frequency of IUI is greater than that of open surgery following laparoscopic hysterectomy (5). Ureter is commonly injured in the lower 1/3 segment, located between the uterine artery and ureterovesical junction (6).
Early diagnosis and immediate repair can minimize ureter-related complications during long-term follow-up (7), although most cases can be detected in the postoperative period (8). The location of the traumatic segment and the type of injury are decisive for the surgical approach chosen for the treatment (9). Ureteroureterostomy or ureteral reimplantation is recommended for the middle and distal ureteral injury (10, 11). However, some studies suggest endourological intervention for first-line treatment in the IUI (12-15). The success rates have been documented across such a broad spectrum due to the heterogeneity of IUI etiology, the low density of cases, and the diversity of treatment options (17-84%) (13-18).
here is no study investigating the effect of treatment results according to injury types the ureter. We aimed to evaluate the etiological factors and their effects on long-term clinical outcomes in patients with IUI.