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Ureteric injury in obstetric and gynaecological surgery

Specialist Registrar in Obstetrics and Gynaecology, Honorary Lecturer in Public Health and Epidemiology, City Hospital, Dudley Road, Birmingham, UK.

Aravinthan Coomarasamy, MD MRCOG

Specialist Registrar in Obstetrics and Gynaecology, Honorary Lecturer in Public Health and Epidemiology, Education Resource Centre, Birmingham Women's Hospital, Metchley Park Road, Edgbaston, Birmingham, B15 2TG, UK. email: arricoomar{at}blueyonder.co.uk (corresponding author)

Kiong Kong Chan, FRCS FRCOG

Consultant Surgeon in Gynaecological Oncology, Director of Gynaecological Oncology, Birmingham Women's Hospital, Birmingham, UK.

Ureteric injury is rare in obstetric and gynaecological practice but, when it occurs, it has serious implications in terms of both morbidity and litigation. In this review, we evaluate the incidence, aetiology, preventive strategies, diagnosis and management of ureteric injury by systematically reviewing the literature. The incidence of ureteric injury varies between 0.1% and 30%, depending on the type of surgery. Prevention can be attempted by preoperative and intraoperative precautions, although the effectiveness of these measures has not been fully evaluated. Diagnosis of ureteric injury may be made intraoperatively but 70% are diagnosed postoperatively. Management depends on the timing of diagnosis, the aetiology, the length and location of the injury, the extent of the causative operation and the condition of the woman.

Keywords Keywords / complications / gynaecology / injury / obstetrics / trauma / ureter