HEALTH OF WOMAN. 2017.2(118):83–87; doi 10.15574/HW.2017.118.83

Sernyak Y. P., Roschin Y. V., Slobodyanyuk E. N., Fukszon A. S., Tkachenko S. V., Mekh V. A.
Donetsk national medical University, Lyman

The injure of the ureter it is one of the most frequent complications in gynecological surgery and occurs according to the literature in the 0.5-30%. There is a great variety of methods of surgical treatment of ureteral injuries, including using modern minimally invasive technologies. But the truth borders of ureteral defeat often differ from the perceived visually, which may cause failures of surgical correction. Application of electroureterography can objectively determine the limits and in accordance defeat ureter level of resection. At the same time the literature have not marks about using of assessment electroureterography during the choose a method of correction of ureteral injury.

The objective: to improve the results of treatment of ureteral injury during obstetric – gynecological surgery by improving methods of surgical correction.

Patients and methods. In the basis researches are the results of clinical observations of 60 patients who performed surgical correction of ureteral injury. The main group of patients represented by 23 (38.3±12.3%) patients, whose injuries correction performed by laparoscopic and classical open access using the electroureterography. In the first control group operative treatment was subjected 21 (35±12.1%) patients who performed a similar surgery but without using electroureterography. In the second control group of 16 (26.7±11.2%) patients made ureteroscopy and installing JJ-stent, and mandatory condition was absence of ureteral wall defect.

Results. The results of treatment assessed considering the subjective and objective criteria by the system of three marks as good, satisfactory and unsatisfactory. Among the 23 patients who were performed surgery using electroureterography, 20 (87±13.7%) patients had a good results. 3 (13±13.8%) patients results were evaluated as satisfactory. Bad results were not observed. 21 patients who performed laparoscopic surgery and by open access without using of electroureterography, founded that 8 (38.1±20.7%) patients had a good results. 9 (42.9±21.1%) patients results were evaluated as satisfactory, and 4 (19±16.8%) patients regarded as bad. Among the 16 patients who performed ureteroscopy with ureteral stenting, in 11 (68.8±22.7%) patients the results were evaluated as good. Five (31.2±22.7%) patients with satisfactory results correspond. Bad results were not observed, it is connected with initial mild ureteral injury in this group of patients (Grade I, classifies Organ Injury Scaling System).

Conclusions. Using the electroureterography during the reconstructive operations has reduced the poor results by 19% compared to similar transactions without using this method. This explained that electroureterografy allows to objectively determine the limits of the ureteric defeat and accordingly level of his resection, and the most appropriate type of surgical treatment of trauma. In the turn, ureteral injury correction using ureteroscopy and stenting, is highly effective if used in patients with mild injuries (Grade I, classifies Organ Injury Scaling System).

Key words: ureteral injury, treatment, gynecological surgery, electroureterography.

REFERENCES

1. Morozov AV, Pavlenko KA. 2004. Pryamoy ureteroenteroanastomoz (vpered, v proshloe?). Urologiya 4:23–27.

2. Mysko SYa. 2011. Yatrogennaya travma mochetochnika – optimalnyiy vyibor lecheniya. Problemi bezperervnoyi medichnoyi osvIti ta nauki. 3:80–85.

3. Stus VP, Moiseenko NN, Dubovskaya NV. 2014. Otdalennyie rezultatyi lecheniya artifitsialnyih povrezhdeniy mochetochnika vo vremya ginekologicheskih i akusherskih vmeshatelstv. Urologiya 18;2(69):11–19.

4. Martov AG, Guschin BL, Ergakov DV i dr. 2002. Endotomiya v lechenii striktur verhnih mochevyih putey. Urologiya 5:39–44.

5. Нао P, Li W, Song C et al. 2008. Clinical evaluation of double-pigtail stent in patients with upper urinary tract diseases: report of 2685 cases. J. Endourol. 22;l: 65–70.

6. Al-Awadi K, Kehinde EO, Al-Hunayan A et al. 2005. Iatrogenic ureteric injuries: incidence, aetiological factors and the effect of early management on subsequent outcome. Int. Urol. Nephrol. 37;2:235–241. https://doi.org/10.1007/s11255-004-7970-4; PMid:16142549

7. Asian P, Brooks A, Drummond M et al. 1999. Incidence and management of gynecological-related ureteric injuries. J. Obstet. Gynecol. 39;2:178–181.

8. Trottmann M, Tritschler S, Graser A et al. 2007. Injuries of the renal pelvis and ureter. Diagnosis and management. Urologe A. 46;8:927–934. https://doi.org/10.1007/s00120-007-1373-y; PMid:17628782

9. Castillo OA, Sanchez-Salas R, Vitagliano G et al. 2008. Laparoscopy-assisted ureter interposition by ileum. J. Endourol. 22;4: 687–692. https://doi.org/10.1089/end.2007.0170; PMid:18336074

10. Mendez LE. 2001. Iatrogenic injuries in gynecologic cancer surgery. Surg. Clin. North Am. 81:897–923. https://doi.org/10.1016/S0039-6109(05)70173-0

11. Park JH, Park JW, Song K et al. 2012. Ureteral injury in gynecologic surgery: a 5-year review in a community hospital. Korean J. Urol. 53;2: 120–125. https://doi.org/10.4111/kju.2012.53.2.120; PMid:22379592 PMCid:PMC3285707