Surgical Treatment of Ureteral Injuries during Gynecological Surgery

The frequency of ureteral injury during gynecological interventions according to different authors is 0,5-30%. There is a great variety of surgical treatment methods of ureteral injuries, including using modern minimally invasive technologies. Type of surgery depends on the severity, extent and location of injury, and the general condition of the patient. But the truth borders of ureteral defeat often differ from the perceived visually, which may cause failures of surgical correction. Intraoperative application of electroureterography can objectively determine the limits and in accordance defeat ureter level of resection. The purpose of the study was to improve the results of ureteral injury treatment during obstetric-gynecological surgery by improving methods of surgical correction. Materials and methods. This research includes the results of clinical observations of 60 patients who performed surgical correction of ureteral injury. The main group of patients is represented by 23 (38,3%±12,3) patients, whose injuries correction were performed by laparoscopic and classical "open" access using the electroureterography. 21 (35%±12,1) patients performed a similar surgery but without using electroureterography in the first control group of operative treatment. In the second control group 16 (26,7%±11,2) patients underwent ureteroscopy and installing JJ-stent. The mandatory condition here was absence of ureteral wall defect. Results and discussion. The results of treatment were assessed considering the subjective and objective criteria by the system of three marks: good, satisfactory and unsatisfactory. Among the 16 patients who performed ureteroscopy with ureteral stenting, the results of 11 (68,8%±22,7) patients were evaluated as good and five (31,2%±22,7) patients with satisfactory results correspondently. Bad results were not observed. This is connected with initial mild ureteral injury in this group of patients (Grade I, classifies Organ Injury Scaling System). Among 21 patients who performed laparoscopic surgery by open access without using electroureterography, only 8 (38,1%±20,7) patients had good results. 9 (42,9%±21,1) patients' results were evaluated as satisfactory, and 4 (19%±16,8) patients' results were regarded as bad. Among the 23 patients who had surgery using electroureterography, 20 (87%±13,7) patients had good results. 3 (13%±13,8) patients' results were evaluated as satisfactory. Bad results were not observed in this group. Conclusions. Using the electroureterography intraoperative during the reconstructive operations has reduced the poor results by 19% compared to similar operations without using this method. This can be explained by the fact that intraoperative electroureterography makes it possible to determine objectively the true functionally active ureter borders and perform its resection within healthy tissue, which eliminates the formation of anastomosis with defective functionally. Moreover, endoscopic ureteral injury correction using ureteroscopy and stenting is highly effective if it is used in patients with mild injuries (Grade I, classifies Organ Injury Scaling System).