Ureteral injuries during classic intrafascial supracervical hysterectomy: an 11-year experience in 1163 patients

STUDY OBJECTIVE: To examine the incidence, characteristics, and treatment of ureteral injuries during classic intrafascial supracervical hysterectomy for benign gynecologic diseases. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: Department of obstetrics and gynecology, university teaching hospital. PATIENTS: A total of 1163 women with benign gynecologic diseases. INTERVENTIONS: Classic intrafascial supracervical hysterectomy. MEASUREMENTS AND MAIN RESULTS: A retrospective chart review was conducted to determine the rate of ureteral injury. Four cases of ureteral injuries occurred among the 1163 classic intrafascial supracervical hysterectomy procedures (0.34%). Ureteral injury occurred during peritoneal dissection in 1 case, which was treated immediately with laparoscopy. In 2 cases, ureteral injuries were recognized by watery vaginal discharge several days after the operation and were treated with laparotomy procedures. Ureteral injury was not detected postoperatively in another case, resulting in a laparoscopic nephrectomy caused by a nonfunctioning kidney 3 years after the initial operation. The predisposing factors for ureteral injury were adhesion as a result of endometriosis, and earlier surgery in which the normal pelvic anatomy was distorted. CONCLUSION: The incidence of ureteral injury during classic intrafascial supracervical hysterectomy as noted in this study is 0.34%. Postoperative cases were associated with high morbidity. Early detection of ureteral injury is crucial for appropriate management as intraoperative diagnosis and repair of the injury then has fewer consequences and less serious complications than postoperative cases.