■医源性输尿管病变是产科和妇科手术后的严重并发症之一。如果不及时诊断和管理,这种情况对肾功能有致命的后果。
■我们研究的目的是报告我们在这种病理管理方面的经验。
■这是一项对32例妇科或产科手术后医源性输尿管损伤患者的回顾性研究,在Rabta医院泌尿科收集了15年的时间(2005-2020年)。临床表现,调查,以及手术和术后细节从患者的图表中进行了回顾。
■患者的平均年龄为42.6(21-61)。在90.6%的病例中观察到多重奇偶校验。子宫切除术是最常见的原因(71.87%),其次是剖宫产手术(18.75%),主要用于胎盘穿孔患者(12.5%),最后,9.37%的病例通过上途径治愈脱垂。症状以腰背痛和尿失禁为主。狭窄是25例中最常见的病变,其次是4例。3例观察到输尿管阴道瘘。患者的一线治疗是输尿管支架引流(15.6%)或经皮肾造瘘术(84.4%)。输尿管膀胱再植26例(81.25%)。然而,一名患者进行了回肠输尿管置换手术。随访期间,7例患者出现治疗失败.4例患者使用尿道支架治疗继发性肾积水,而3例患者需要肾切除术。妇科和产科手术的类型(开腹子宫切除术),骨盆手术史,恶性病理是治疗失败的预测因素。
■在妇科和产科手术中对输尿管的损伤通常很少见。修复技术的多样性和泌尿外科技术的贡献最常允许保留肾脏,知道最好的治疗方法仍然是预防。
UNASSIGNED: Iatrogenic ureteral lesions represent one of the serious complications that can follow obstetric and gynecological surgery. This condition has a fatal consequence on renal function if it\'s not promptly diagnosed and managed.
UNASSIGNED: The aim of our study was to report our experience in the management of this pathology.
UNASSIGNED: This is a retrospective study of 32 patients treated for an iatrogenic ureteral injury after gynecological or obstetrical surgery, collected in the urology department of the Rabta Hospital over a 15-year period (2005-2020). Clinical presentation, investigations, and operative and postoperative details were reviewed from the patients\' charts.
UNASSIGNED: The average age of the patients was 42.6 (21-61). Multiparity was observed in 90.6% of cases. Hysterectomy was the most common cause (71.87%), followed by cesarean operation (18.75%), mainly for patients with placenta percreta (12.5%), and lastly, cure of prolapse by the upper approach in 9.37% of cases. The symptoms were dominated by low back pain and urinary incontinence. Stenosis was the most frequent lesion in 25 cases, followed by a section in 4 cases. A ureterovaginal fistula was observed in 3 case s. The first-line treatment of the patients was drainage by a ureteral stent (15.6%) or by a percutaneous nephrostomy (84.4%). Ureterovesical reimplantation was performed in 26 cases (81.25%). However, one patient had an Ileal ureter replacement. During follow-up, treatment failure was noted in 7 patients. Four patients developed secondary hydronephrosis treated with a urethral stent while 3 patients required nephrectomy. The type of gynecological and obstetrical procedure (open hysterectomy), history of pelvic surgery, and malignant pathology were predictive factors of treatment failure.
UNASSIGNED: Injuries to the ureter during gynecological and obstetrical surgery are generally rare. The diversity of repair techniques and the contribution of endo-urological techniques most often allow renal preservation, knowing that the best treatment remains prevention.