Original Article Ureteral Injuries During Gynecological Surgery A. Liapis, P. Bakas, V. Giannopoulos and G. Creatsas University of Athens, Aretaieion Hospital, Greece Abstract: The purpose of this study was to review the cases of ureteric injuries during major pelvic surgery that occurred in our department over the last 15 years, in relation to possible predisposing factors and patient management according to the type of injury. From 5122 major gynecologic operations we found 18 cases of ureteric injury, including 4 cases of urinoma. Parameters that were examined included the indication for surgery and the type of operation, coexisting pathological conditions, the position of and the delay in recognition of the ureteric damage. The incidence of ureteric injury was 0.35%. The time of recognition of injury in 9 cases was during primary surgery and end-to-end anastomosis was performed, whereas in the other 9 cases the injury was recognized after surgery and repair of the ureter was performed, with reimplantation into the bladder in 4 cases and end-to-end anastomosis in 5. Action to prevent the development of iatrogenic ureteral injury must be taken in advance, and the management of ureteric injuries could be improved with prompt recognition and repair by a skilled surgeon. Keywords: Gynecologic surgery; Ureteral injury; Ur- inomas Introduction Ureteric injury is one of the most serious complications of gynecologic operations in the pelvis. It has a frequency ranging from 0.5% to 1.5% for all major pelvic operations [1]. Ureteric damage has a significant morbidity and can present as ureteric stenosis or obstruction, ureterovaginal fistula, and in some cases with hydronephrosis and variable degrees of impaired renal function. Because of the possibility of renal damage, ureteric injury during pelvic surgery appears to be more serious than damage to the urinary bladder or the rectum. Ureteric damage during pelvic surgery remains an important concern for the gynecologist, who should be prepared to recognize and manage such injuries. Purpose of this study was to review the cases of ureteric injury during major pelvic surgery that had occurred in our department during the past 15 years, in relation to possible predisposing factors and patient management according to the type of injury. Materials and Methods We examined the files of all major gynecological operations that were associated with ureteric injury during the past 15 years and, from 5122 such cases we found 18 that suffered ureteric injury including 4 cases of urinoma. Parameters that were examined included the indication for surgery and the type of operation performed, coexisting pathological conditions, the posi- tion of and the delay in recognition of the ureteric damage, and the method of ureteric repair. When the ureteric damage was diagnosed after the operation, we examined the symptoms that developed and the diag- nostic methods that were used to evaluate the damage. We also examined the clinical or pathological conditions that predispose to the development of ureteric damage. Results From 5122 major gynecological operations we found 18 cases of ureteric injury, 13 of which concerned the right and 5 the left ureter. The incidence of ureteric injuries Int Urogynecol J (2001) 12:391–394 ß 2001 Springer-Verlag London Limited International Urogynecology Journal Correspondence and offprint requests to: A. Liapis, Assistant Professor in Obstetrics and Gynecology, 9A, N. Paritsi, 15451 Athens, Greece. Fax: 003-01-6712188