Intraoperative diagnosis of ureteral injuries in gynecological surgery

Yu.P. Sernyak, Yu.V. Roschin, E.N. Slobodyanyuk, S.V. Tkachenko, A.S. Fukszon, M.V. Kryshtopa, V.A. Mekh

Abstract


Ureteral injury is one of the most frequent complications in gynecological surgery and, according to the literature, occurs in 0.5–30 % of cases. Intraoperative detection of ureteral injury in gynecological practice, according to various literature sources, takes place in 7–39 % of cases; usually, it is revealed postoperatively. At the same time, intraoperative identification of ureteral injury provides the most timely and effective correction. The article deals with a multivariate analysis of survey data of 161 patients who have had gynecological surgery, it presents the most significant risk factors for ureteral injury and a quantitative assessment of their significance. A way to classify patients according to risk of injury is described. The principles of intraoperative diagnosis of ureteral damage are deve­loped taking into account the risk of injury. For early intraoperative detection of ureteral injury, it is necessary to observe the following principles of diagnosis: in patients with a low risk of ureteral damage, in case of excessive intraoperative bleeding or suspected injury, cystoscopy or intravenous administration of 5 ml of 0.4% indigo carmine solution should be performed. If the injury was not eliminated, the urologist should be involved in the operation, the urinary tract is to be checked; if necessary, the ureteroscopy is performed; for patients with a high risk of ureteral injury, insertion of jj-stents or ureteral catheters is indicated. If intraoperative bleeding occurs or injury is suspected, the maximum possible revision of the urinary tract should be performed involving urologist, if possible — intravenous injection of 5–10 ml of 0.4 % indigo carmine solution. If the trauma was not eliminated, cystoscopy and ureteroscopy are indicated.

Keywords


ureteral injury; intraoperative diagnosis; gynecological surgery

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DOI: https://doi.org/10.22141/1997-2938.3.34.2017.115737

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