Published: 2021-01-29

Ureteric injuries during cancer surgery presentation and management over a 20-year

Ali Zedan Tohamy, Haisam A. Samy, Tark Salah, Marwa T. Hussien, Mohamed Hussein


Background: Iatrogenic ureteral injury rare 0.3-1.5%. complication of abdominopelvic cancer surgery. We aimed to study the risk and management of ureteral injury among cancer patients.  

Methods: Diagnosis can be achieved retrograde pyelography, ureteroscopy, CT, or intravenous urography.

Results: Years 2000 to 2020, 2904 patients in the Department of Surgical oncology, Assuit University, and 47 ureteral injury cases were identified. (1.62), 4/231 cervical cancer, 9/611 ovarian cancer and 7/462 endometrial cancer.,11/818 colon cancer,12/620 rectal cancer, 1/11 prostatic cancer, 3/151 retroperitoneal sarcoma. 34% (radical abdominal hysterectomy 8.5% Wertheim hysterectomies 4%), colorectal surgery colectomy 25.5%, low anterior resection2.1% in radical prostatectomy and 6.4% in retroperitoneal tumor, intraoperative diagnosis 48.9%, 8.5% in laparoscopic surgeries, the distal third (53.2%),23.4% catheterization, complete transection 31.9%; partial 14.9%, ligation 8.5%, laceration in 19.1%, resection. 8.5%; and devascularization in 17%. Fever in 14.9%, abdominal or flank pain in 38.5%. Oligura in 6.4%, ileus in 19.3%, urinary leakage (vaginally or via abdominal wound) in 10.6% rise creatinine in 10.6%, hydronephrosis in 6.4%, urinoma in 27.7%, extravasation in 8.5% asymptomatic in 4.3%, 40.4% percutaneous nephrostomy. 19.1%primary repair Ureteroneocystostomy in (17%) Boari flap in 12.7%, Psoas hitch in 23.4% stenting in 14.9%, 8.5% ileum interposition, anastomosis to contralateral ureter in 4.3%, ureteral stricture 6.4%, ureterovaginal fistulas in 10.6%, acute renal failure 2.1%, peritonitis 4.3, urinary tract infection in 14.9%.

Conclusions: The recognition and immediate repair of ureteral injuries early during the same procedure was highly desirable and to avoid a second operation.


Iatrogenic ureteral injury, Oncological surgery, Morbidity

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Patil SB, Guru N, Kundargi VS, Patil BS, Patil N, Ranka K. Post hysterectomy ureteric injuries: presentation and outcome of management. Urol Ann. 2017;9(1):4.

Neagoe CO, Mazilu O. Pelvic intraoperative iatrogenic oncosurgical injuries: single-center experience. Offic J Balk Union Oncol. 2016;21(2):498-504.

Abboudi H, Ahmed K, Royle J, Khan MS, Dasgupta P, N'dow J. Ureteric injury: a challenging condition to diagnose and manage. Nature Rev Urol. 2013;10(2):108.

Yellinek S, Krizzuk D, Nogueras JJ, Wexner SD. Ureteral Injury During Colorectal Surgery: Two Case Reports and a Literature Review. J Anus Rectum Colon. 2018;2(3):71-6.

Lawal O, Bello O, Morhason-Bello I, Abdus-salam R, Ojengbede O. Our experience with iatrogenic ureteric injuries among women presenting to University College Hospital, Ibadan: A call to action on trigger factors. Obstet Gynecol Int. 2019;2019.

Afzal M. Urological Injuries in Obstetrics and Gynecological Surgery. J Rawalpindi Med Col. 2015;19(3):243-6.

Siow A, Nikam YA. Urological complications of laparoscopic hysterectomy: four. Singapore Med J. 2007;48(3):217-21.

Rani AK, Singh B, Kumar S. Urological injuries in gynecological surgery: A review. Int J Clinic Obstet Gynaecol. 2020;4(2): 409-12.

Hoffman MS. How to safeguard the ureter and repair surgical injury. OBG Managem. 2008,20(11):60

Durrani SN, Rehman A, Khan S, Ullah H, Khan MK, Ullah A. Ureteral trauma during open surgery: etiology, presentation and management. J Ayub Med Coll Abbottabad. 2013;25(3-4):86-9.

Halabi WJ, Jafari MD, Nguyen VQ, Carmichael JC, Mills' S, Pigazzi A et al. Reteral injuries in colorectal surgery: an analysis of trends, outcomes, and risk factors over a 10-year period in the United States. Diseases Colon Rect. 2014;57(2):179-86.

Nerli RB, Ghagane SC, Kadeli V, Hiremath MB. Ureteric Injuries During Laparoscopic Gynecologic Surgeries. J Sci Soc. 2019;46:3‑7.

Merritt AJ, Crosbie EJ, Charova J, Achiampong J, Zommere I, Winter-Roach B, et al. Prophylactic pre-operative bilateral ureteric catheters for major gynecological surgery. Arch Gynecol Obstet. 2013;288(5):1061-6.

Desai RS, Kumar S. Urological injuries during obstetric and gynecological procedures: a retrospective analysis over a period of eleven years. Int J Reproduct, Contracept, Obstet Gynecol. 5(6):1917.

Gild P, Kluth LA, Vetterlein MW, Engel O, Chun FK, Fisch M. Adult iatrogenic ureteral injury and stricture–incidence and treatment strategies. Asian J Urol. 2018;5(2):101-6.

Milonas D, Stirbys S, Jievaltas M. Successful treatment of upper ureteral injury using renal auto transplantation. Medicina. 2009;45(12):988.

Papanikolaou A, Tsolakidis D, Theodoulidis V, Ioannidis E, Vatopoulou A, Kellartzis D. Surgery for ureteral repair after gynecological procedures: a single tertiary center experience. Arch Gynecol Obstet. 2013;287(5):947-50.

Jha S, Coomarasamy A, Chan KK. Ureteric injury in obstetric and gynecological surgery. Obstetric Gynecolog. 2004;6(4):203-8.

Zhong W, Hong P, Ding G, Yang K, Li X, Bao J, et al. Technical considerations and outcomes for ileal ureter replacement: a retrospective study in China. Bio Med Cent Surg. 2019;19(1):9.