A E Aghaji1, C Odoemene. 1. Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
Abstract
OBJECTIVE: To study the aetiology, mode of presentation and treatment outcome of ureteric injuries in Enugu. DESIGN: A prospective study carried out between January 1986 and December 1997. SETTING: Three busy health institutions in Enugu, Nigeria, namely, University of Nigeria Teaching Hospital, Mother of Christ Specialist Hospital and JAMA Urological Clinic. SUBJECTS: All patients presenting with ureteric injuries during the study period. INTERVENTIONS: Exploration and reconstruction of the injured ureter. MAIN OUTCOME MEASURES: Intravenous urography three months post operatively. RESULTS: One hundred and forty-eight patients were treated, out of which fifteen had bilateral injuries. All the injuries except one, occurred during operations for various abdominal and pelvic conditions. Fifteen males (10.1%) and 133 females (89.9%) were involved. Gynaecological operations accounted for majority of cases (87.8%). The type of injury was either transection or ligation. The left ureter was injured more than the right (52.1% and 47.9%, respectively). In 71 patients (48.0%), there was a fistula between the injured ureter and the vagina, presenting clinically with urinary incontinence. In 39 patients (26.4%), the injuries were discovered at surgery while the rest presented after the offending surgery. Ureteroneocystostomy, end-to-end ureteric anastomosis, and ileal interposition were the reconstructive methods adopted. All the renal units were salvaged and all the patients survived the procedures, however, post-operative IVU in four patients showed ureteric reflux. CONCLUSION: Open gynaecological operations are still the leading cause of ureteric injuries in Nigeria.
OBJECTIVE: To study the aetiology, mode of presentation and treatment outcome of ureteric injuries in Enugu. DESIGN: A prospective study carried out between January 1986 and December 1997. SETTING: Three busy health institutions in Enugu, Nigeria, namely, University of Nigeria Teaching Hospital, Mother of Christ Specialist Hospital and JAMA Urological Clinic. SUBJECTS: All patients presenting with ureteric injuries during the study period. INTERVENTIONS: Exploration and reconstruction of the injured ureter. MAIN OUTCOME MEASURES: Intravenous urography three months post operatively. RESULTS: One hundred and forty-eight patients were treated, out of which fifteen had bilateral injuries. All the injuries except one, occurred during operations for various abdominal and pelvic conditions. Fifteen males (10.1%) and 133 females (89.9%) were involved. Gynaecological operations accounted for majority of cases (87.8%). The type of injury was either transection or ligation. The left ureter was injured more than the right (52.1% and 47.9%, respectively). In 71 patients (48.0%), there was a fistula between the injured ureter and the vagina, presenting clinically with urinary incontinence. In 39 patients (26.4%), the injuries were discovered at surgery while the rest presented after the offending surgery. Ureteroneocystostomy, end-to-end ureteric anastomosis, and ileal interposition were the reconstructive methods adopted. All the renal units were salvaged and all the patients survived the procedures, however, post-operative IVU in four patients showed ureteric reflux. CONCLUSION: Open gynaecological operations are still the leading cause of ureteric injuries in Nigeria.