Mohammed Shahzad Anwar, Mohammed Tariq, Khalid Saeed, Tariq Ghafoor, Ghulam Mustafa.
Causes of ureteric injuries and outcome of different surgical procedures for the repair of ureter.
J Sheikh Zayed Med Coll Jan ;1(1):16-20.

Background: latrogenic ureteric injuries have long been recognized as a potential complication of any abdominal or pelvic surgery. The present descriptive study was conducted at the Department of Urology Services Hospital, Lahore and Sheikh Zayed Medical College Rahim Yar Khan. Objectives: The specific objective of the study was to determine causes of ureteric injures and outcome of various treatment options. Patients & Methods: A total of 40 patients included in the study were presented either in the emergency ward or referred from other wards. Detailed History and thorough general and physical examination was done. Routine investigations were done in all cases while ultrasonography, intravenous urography, retrograde urography, antegrade urography and Computed Tomography (CT) scan were done in selected cases. Various procedures for ureteral repair were performed according to the site and extent of injury. Ureteral repair was done over a DJ stent. Results: In our study out of 40 patients 33 (82.5%) were female and 7 (17.5%) males. Mean age of patients was 36 years. Maximum number of patients had lower ureteric injuries i.e 29 (72.5%) while 8 (17.5%) had upper ureteric injuries and 3 (7.5%) presented with mid ureteric injuries. 38 (95%) patients presented with iatrogenic injuries and 2 (5%) patients with firearm injury. Abdominal hysterectomy was the main cause in lower ureteric injuries. In case of upper and mid ureteric injures pyeloplasties and ureterouretrostomy was performed while in case of lower ureteric injuries 27 patients underwent extravesical and intravesical ureteroneocystostomy. Boari flap with psoas hitch was performed in two patients. Patients were followed at fourth week, three months and six months interval. Success rate in upper and mid ureteric injuries were 100% while in case of lower ureteric injuries it was (93.1%). Conclusion: Ureteric injury causes a considerable morbidity for the patients. Detail understanding of anatomical relations of ureter and meticulous surgery will prevent iatrogenic injuries. The most common lower ureteric injuries can be best managed with Modified Liche (taguchi) technique.

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