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Iatrogenic Ureteric Injuries following Abdomino-pelvic Operations: A 10-year Tertiary Care Hospital Experience in Tanzania.

Chalya, P. L., Massinde, A. N., Kihunrwa, A. and Simbila, S. (2015) Iatrogenic Ureteric Injuries following Abdomino-pelvic Operations: A 10-year Tertiary Care Hospital Experience in Tanzania. World journal of emergency surgery : WJES, 10. p. 17. ISSN 1749-7922

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Iatrogenic ureteric injuries are rare complications of abdomino-pelvic surgery but associated with high morbidity and even mortality. There is paucity of data regarding iatrogenic ureteric injuries in Tanzania and Bugando Medical Centre in particular. This study describes our experience in the management and outcome of ureteric injuries following abdomino-pelvic operations outlining the causes, clinical presentation and outcome of management of this condition in our local setting. This was a retrospective descriptive study of patients with iatrogenic ureteric injuries following abdomino-pelvic operations that were managed in Bugando Medical Centre between July 2004 and June 2014. A total of 164 patients (M: F = 1: 1.6) were studied. Of these, 154 (93.9%) were referred to Bugando Medical Centre having had their initial surgeries performed at other hospitals, whereas 10 (6.1%) patients sustained ureteric injuries during abdomino-pelvic surgery at Bugando Medical Centre. The median age at presentation was 36 years. The most common cause of iatrogenic ureteric injuries was total abdominal hysterectomy occurring in 69.2% of cases. The distal ureter was more frequently injured in 75.6% of cases. Suture ligation was the commonest type of injury accounting for 36.6% of patients. One hundred and sixteen (70.7%) patients had delayed diagnosis but underwent immediate repair. Ureteroneocystostomy was the most frequent reconstructive surgery performed in 58.0% of cases. Of the 164 patients, 152 (92.7%) were treated successfully. Twelve (7.3%) patients died in hospital. The main predictors of deaths were delayed presentation, deranged renal function tests on admission, missed ureteric injuries and surgical site infections (P < 0.001). The overall median length of hospital stay was 12 days. Follow up of patients was generally poor as more than half of patients were lost to follow up. Total abdominal hysterectomy still accounts for most cases of iatrogenic ureteric injuries in our environment. Meticulous surgical technique as well as identification of the course of the ureter and associated anatomic locations where injury is most likely to occur is important to decrease the risk of ureteric injury. Timely recognition of ureteric injury and its management is associated with good outcome.

Item Type: Article
Keywords: Ureteric injuries, Iatrogenic, Abdomino-pelvic operations, Management, Outcome, Tanzania
Subjects: Non-communicable disease (NCD) > Injury & Accidents
Divisions: Catholic University of Health and Allied Sciences (CUHAS)
Depositing User: Mr Joseph Madata
Date Deposited: 18 Mar 2015 08:26
Last Modified: 18 Mar 2015 08:26

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