Surgical Treatment of Ureteral Injuries During Gynecological Surgery
According to different authors the rate of ureteral injuries during gynecological interventions is 0.5–30 %, on the average 1–12 %. There is a great variety of methods of surgical treatment of ureteral injuries, including modern minimally invasive technologies. Type of surgery depends on the severity, extention and location of injury, and the general condition of the patient. But the real borders of ureteral lesion often differ from the visual ones, which may cause failures of surgical treatment. Intraoperative application of electroureterography can objectively determine the limits and discordance of the lesion and therefore the level of ureter resection. At the same time the literature have not data about intraoperative assessment by electroureterography while choosing a method of correction of ureteral injury. Objective. To improve the results of treatment of ureteral injury during obstetric-gynecological intervention by improving methods of surgical correction. Materials and methods. The research is based on the results of clinical observations of 60 patients who were performed surgical correction of ureteral injury. The main group involved 23 (38.3 ± 12.3 %) patients undergone laparoscopy and classical open access with electroureterography. In the first control group operative treatment consisted of 21 (35.0 ± 12.1 %) patients who were performed a similar surgery but without electroureterography. In the second control group of 16 (26,7 ± 11,2 %) patients ureteroscopy was made with JJ-stent installing, and mandatory condition was the absence of ureteral wall lesion. Results and discussion. The results of treatment were assessed considering the subjective and objective criteria by the three-points system as good, satisfactory and unsatisfactory. Among the 16 patients who were performed ureteroscopy with ureteral stenting, in 11 (68.8 ± 22.7 %) patients the results were evaluated as good. Five (31.2 ± 22.7 %) patients had satisfactory results. Bad results were observed in no one, it is connected with initially mild ureteral injury in this group of patients (grade I, by Organ Injury Scaling System). Among 21 patients who performed laparoscopic surgery and by open access without using of electroureterography 8 (38.1 ± 20.7 %) patients were found to have good results. The results of 9 (42.9 ± 21.1 %) patients were evaluated as satisfactory, and 4 (19.0 ± 16.8 %) patients had bad results. Among the 23 patients who were performed surgery with electroureterography, 20 (87.0 ± 13.7 %) patients had good results. 3 (13.0 ± 13.8 %) patients had satisfactory results. Bad results were observed in no one. Conclusions and practice recommendations. The intraoperative usage of electroureterography during the reconstructive operations has reduced the poor results by 19% compared to similar transactions without this method. This could be explained by the potential of intraoperative electroureterography to determine objectively the ureter real borders of functionally active ureter and perform its resection within healthy tissue, which eliminates the formation of anastomosis of defective ureter. Whereas endoscopic ureteral injury correction using ureteroscopy and stenting is highly effective if used in patients with mild injuries (grade I, by Organ Injury Scaling System).
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