TITLE:
Iatrogenic Lesions of the Ureter Following Obstetric or Gynaecological Surgery Managed at Yalgado Ouedraogo University Hospital: A Series of 14 Cases
AUTHORS:
Timongo Françoise Danielle Millogo/Traore, Kiswendsida Bonkoungou, Fasnéwindé Aristide Kabore, Ali Ouedraogo, Léonie Claudine Lougue/Sorgho
KEYWORDS:
Iatrogenic Lesion, Ureter, Obstetric and Gynaecological Surgery
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.8 No.2,
February
8,
2018
ABSTRACT: Objective: To describe the aetiology, clinical presentation, management and
outcomes of a series of patients with iatrogenic lesions of the ureter
following obstetric or gynaecological surgery treated at Yalgado Ouedraogo
University Hospital, Ouagadougou, Burkina Faso. Methods: This is a case
series looking at 14 consecutive patients from 1 January 2011 to 28 February
2017, operated on for urological complications following obstetric and gynaecological
surgery. Results: Our study focused on fourteen cases. The average age
was 32.9 years (range 20 - 60 years). Thirteen were
housewives. Eleven lived in rural areas. The aetiological factor was Caesarian
section in seven cases, laparotomy in four cases and hysterectomy in three cases. The type of ureteral
injury was bilateral ligation in nine cases. The average time to diagnosis was
16 days (range 2 - 120 days). Anuria was the
commonest presenting symptom. Ultrasound in ten patients showed evidence of uretero-hydronephrosis.
Eight patients required renal dialysis. Surgical management was uretero-vesical
re-implantation
in eleven cases, disunion of sutures associated with catheterization in two
cases and a termino-terminal ureteral anastomosis in one case. The average hospital
stay was 26 days (range 9 - 44 days). The
post-operative period was complicated by two cases of vesico-vaginal fistula,
one case of parietal suppuration, one case of pyelonephritis and one case of
hydronephrosis. No deaths were recorded and a complete cure was ultimately
obtained in all patients. Conclusion: Urological complications of
obstetric and gynaecological surgery are dominated by ligation of the ureters
in our setting. Caesarian section is the commonest cause. Treatment is
essentially surgical.