Most occurrences of Iatrogenic ureteral injury (IUI) occurrences are not recognized until the patient comes with symptoms following pelvic surgery or radiotherapy. Recently, less invasive techniques have been employed increasingly frequently in treating IUI. This study examined urological intervention success rates and long-term clinical effects according to the kind of IUI following a hysterectomy. About 27 patients who underwent surgery due to IUI in our clinic following a hysterectomy were studied between January 2011 and April 2018. Patients were grouped according to the time of diagnosis of IUI. The IUI instances identified during the first 24 h following hysterectomy were defined as “immediate” IUI, whereas that diagnosed late period was considered ‘delayed’ IUI. The type of IUI was categorized as “cold transaction” due to surgical dissection or ligation without any thermal energy and “thermal damage” if it was associated with any energy-based surgical equipment. Patient information, laboratory and perioperative data, imaging examinations, and complications were examined retrospectively. All cases of delayed diagnostic IUI were secondary to surgical hysterectomy (P=0.041). Patients with heat injury to the ureter were mostly identified late (delayed) (P=0.029). The majority (69%), not the minority (31%), of patients who required endourological intervention were diagnosed later. The numbers for patients who underwent open reconstructive surgery were 73% and 27% (P=0.041), respectively. After the urological procedure, researchers found eight cases of patients experiencing ureteral problems. All of these unsuccessful cases had a common denominator: endourological treatment (P=0.005) and thermal damage as the underlying cause of the IUI (P=0.046). Patients undergoing open urological reconstruction surgery have shown no signs of experiencing problems. About 7 of the 8 individuals who experienced urological issues were part of the delayed group (P=0.016), whereas the other 1 was part of the immediate group. Delayed diagnosed IUI after hysterectomy is treated with endourological intervention more often, but success rates are low if heat damage has been established in the ureter. If the ureter has been damaged by heat, surgical repair is the best option to prevent further difficulties.
Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-022-01094-5
