In 19 women (aged 27-66 years, mean 44.6 years) a retrospective analysis of the urological complications suffered during gynecological surgery was performed. 14 (73.6%) patients had ureteral injuries with concomitant bladder lesions in two. In the remaining 4 (21%) bladder injury only was present including a woman with a simultaneous urethral lesion. In the postoperative period 3 ureteric, 5 vesicovaginal, and one vesicouterine fistula developed. Intraoperative diagnosis followed by immediate surgical repair of the ureteric and bladder lesions was performed in 2 (10.5%) patients only. Except one case ureteral injury was unilateral, and predominantly right-sided (10:5). One patient suffered injury of one of the ureters in a complete ureteral duplication. The most frequent side of ureteral injury was at the level of the uterine artery with complete ligature of the ureter in 10 (71.4%), and partial in 4 (28.6%) patients. Percutaneous nephrostomy as a temporary diversion was performed in 8 (57.1%) patients. Definitive treatment involved simple Paquin ureteral reimplantation in 5 patients, Boari's procedure in 3, and psoas hitch technique once. Ureteral lysis only was sufficient in 3 patients. The surgical treatment including repair of vesical fistulas was in all cases successful.

Urologická klinika LF UPJS Kosice