Iatrogenic ureteric injuries complicating open obstetric and gynaecologic operations in South East Nigeria - case series.

Background: Iatrogenic ureteric injury(IUI) in open obstetric and gynaecological surgeries is uncommon, with an incidence of 0.4-2.5%. It is however less uncommon in some specific vaginal and urethral suspension surgeries. The left ureter is more commonly damaged in the pelvis than the right ureter. The common mechanisms of injury include ligation, transection and crushing. Most of these injuries are unnoticed at the primary surgery, but are recognized in the immediate post-operative period. Iatrogenic ureteric injury increases morbidity, though mortality is rare.

Results: A total of six patients had iatrogenic ureteric injuries during open pelvic operations in this study between January 2009 and December 2010. All the patients had a mean age of 38.5years and a range of 27-50 years. The primary surgery for three of the cases were done by consultant gynaecologists, two by medical officers who were yet to undergo residency training, while the status of the surgeon in one case could not be ascertained. The left ureter was injured in 5(83%) patients, with ligation being the commonest mechanism of injury in 83% of cases. Recognition of the ureteric injuries was in the post-operative period in all the cases in this report. The commonest presenting feature was leakage of urine via a uretero-vaginal fistula in 67% of cases and through the surgical wound in one(17%) patient.

Conclusion: Iatrogenic ureteric injuries do complicate pelvic surgeries in this environment and often present as urinary fistula in the immediate post operative period; majority are missed intra-operatively.