Injuries of the ureter caused by gynecologic surgery. Experience in the treatment of 42 cases
Tramoyeres Celma, A.; Alonso Gorrea, M.; Pastor Sempere, F.; Rodríguez Hernández, J.; Santolaya García, J.I.
Archivos Espanoles de Urologia 33(1): 19-50
1980
ISSN/ISBN: 0004-0614 PMID: 7362279 Document Number: 154407
These operations, in which the risk is essentially ureteral, must be carried out in a urological rather than gynaecological way; the said ureter must be sought after a permanent, ureteral probe has been placed before the operation. We feel that a vaginography is more useful than a retrograde pyelography for diagnosing ureterovaginal fistulae. Another important indication is the need for an intravenous urography to be systematically carried out in the postoperative period of all pelvis operations. Only I.V.U. enables the discovery in time of ureteral lesions which would otherwise remain undiscovered too long. We feel that nephrostomy is an emergency therapy in cases of anuria and septic shock with a urinary focus. It is a safety measure for preventing kidney deterioration in ureter lesions which have remained undiscovered for a long time. In pelvic ureter lesions and providing that there is no vesical retraction, we perform a vesical psoization along with the ureterocystoneostomy (1). When the ureteral lesion is bilateral and the elasticity of the bladder enables us to do so, we perform a ureterocystoneostomy with vesical bipartition and psoization of both vesical wings. In cases of extensive, bilateral ureteral lesions associated with vesical damage such as: vesico-vaginal fistulae and retracted bladder, we perform a ureteroileocystoplasty and vesical stretching.