Introduction/Background Urinary tract injury during laparoscopic hysterectomy has become more common. The incidence of ureteral injuries is 0.3–2% for benign diseases and reaches 10% in case of malignancy.
This work represents our experience in laparoscopic management of urinary tract injuries during totally laparoscopic radical hysterectomy (TLRH) for cervical cancer.
Methodology n 2010–2018 we performed 138 TLRH for cervical cancer. Urinary tract complications occurred in 10 (7.2%) patients. Among them there were 5 (3.6%) ureteral and 5 bladder damages. All ureteral injuries occurred in patients with history of chemoradiotherapy and were diagnosed within 30 days after surgery.
In case of intraoperative bladder damage simple suture and 9 days of catheter were enough. One ureteral damage was treated on 2nd p/o day with relaparoscopy and ureteral suturing on stent. In one case of ureteral necrosis due to the devascularisation of ureter during dissection unsuccessful attempts were made to treat it with stent. After one year uretero-ileo-neocystoplasty was performed. In three cases of ureteral necrosis primary ureterocystoneostomies with psoas hitch were done.
Results Mean operative time of ureteral reconstruction was 132.3 min. Mean hospital stay was 4.7 days. Cystography showed no urine leak when the ureteral stent was removed at 4–6 weeks after procedure. Ureteral stent was removed after cystography at 4–6 weeks. Ureteroneocystostomy patency was followed up with cystography at 6–8 months.
Conclusion Urinary tract injury during laparoscopic hesterectomy is rare but in case of ureteral damage very serious complication that can be successfully treated laparoscopically by experienced surgeon.
Disclosure Nothing to disclose.
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