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).