Iatrogenic Lesions of the Ureter Following Obstetric or Gynaecological Surgery Managed at Yalgado Ouedraogo University Hospital: A Series of 14 Cases

摘要

>Objective: style="font-family:;" "=""> style="font-family:Verdana;"> To describe the aetiology, clinical presentation, management and outcomes of a series of patients with iatrogenic lesions of the ureter following obstetric or gynaecological surgery treated at Yalgado Ouedraogo University Hospital, Ouagadougou, Burkina Faso. style="font-family:Verdana;">Methods style="font-family:Verdana;">: This is a case series looking at 14 consecutive patients from 1 January 2011 to 28 February 2017, operated on for urological complications following obstetric and gynaecological surgery. style="font-family:Verdana;">Results style="font-family:Verdana;">: Our study focused on fourteen cases. The average age was 32.9 years (range 20 style="font-family:;" "=""> style="font-family:Verdana;">- style="font-family:;" "=""> style="font-family:Verdana;">60 years). Thirteen were housewives. Eleven lived in rural areas. The aetiological factor was Caesarian section in seven cases, laparotomy in four style="font-family:;" "=""> style="font-family:Verdana;">cases and hysterectomy in three cases. The type of ureteral injury was bilateral ligation in nine cases. The average time to diagnosis was 16 days (range 2 style="font-family:;" "=""> style="font-family:Verdana;">- style="font-family:;" "=""> style="font-family:Verdana;">120 days). Anuria was the commonest presenting symptom. Ultrasound in ten patients showed evidence of uretero-hydronephrosis. Eight patients required renal dialysis. Surgical management was uretero-vesical re style="font-family:Verdana;">- style="font-family:Verdana;">implantation in eleven cases, disunion of sutures associated with catheterization in two cases and a termino-terminal ureteral anastomosis in one style="font-family:;" "=""> style="font-family:Verdana;">case. The average hospital stay was 26 days (range 9 style="font-family:;" "=""> style="font-family:Verdana;">- style="font-family:;" "=""> style="font-family:;" "=""> style="font-family:Verdana;">44 days). The post-operative period was complicated by two cases of vesico-vaginal fistula, one case of parietal suppuration, one case of pyelonephritis and one case of hydronephrosis. No deaths were recorded and a complete cure was ultimately obtained in all patients. style="font-family:Verdana;">Conclusion: style="font-family:Verdana;">Urological complications of obstetric and gynaecological surgery are dominated by ligation of the ureters in our setting. Caesarian section is the commonest cause. Treatment is essentially surgical.