Iatrogenic ureteric injuries in open abdominopelvic surgery: a five year experience in Maiduguri, North Eastern Nigeria

摘要

Background: Ureteric injuries during open abdominopelvic procedures though rare, are often associated with high morbidity and mortality especially when they present late. Late presentation is the norm as most injuries occurred during non-urological procedures and patients subsequently referred to urologist. Methods: The study reviewed iatrogenic ureteric injuries managed by the urology unit in the University of Maiduguri Teaching Hospital between January 2011 and December 2015. Results: A total of 19 patients (23 injured ureters), age ranged from 9 to 70 years, with a mean of 38.42 years and Female to male ratio of 2.17:1. Clinical features were renal failure with anuria in 21.05% and leakage of urine in 57.89%. Duration of symptoms ranged from 5 to 39 days. Injuries were sustained during caesarean section in 36.84% and retroperitoneal tumour resection in 31.58%. Pattern of injuries were left ureter in 39.13%, right in 26.08%, and bilateral in 4 patients 21.05% of patients- accounting for 34.78% of injuries. Procedures done were uretero-neocystostomy in 60.87% ureters and Boari flap with Psoas hitch in 17.39%. Post-operative complications were, surgical site infection 15.79% and urosepsis in 26.34%. Mortality was 15.79%. Conclusions: Iatrogenic ureteric injuries though rare are associated with high morbidity and mortality. Early detection especially during surgery and immediate repair will reduce morbidity and mortality.