Endoscopic methods for the diagnosis and treatment of ureteral injuries after gynecological and obstetric surgeries

Objective. To determine the role and effectiveness of endoscopic diagnostic and treatment methods in patients with ureteral injury (UI) diagnosed after obstetric and gynecological surgery.
Materials and methods. A retrospective analysis of 95 medical records of patients with PM was performed. Nine (9.5 %) women had previously undergone surgery in obstetric departments, 61 (64.2 %) – in gynecological departments for benign diseases, 25 (26.2 %) – in gynecological or oncogynecological departments for malignant diseases (stage Tis-T2N0M0). The age of patients ranged from 19 to 72 years (mean age 47.2 ± 7.3). The time of admission to the urology hospital after the primary obstetric or gynecological surgery varied from 2 to 38 days. Among benign formations in gynecology, the most common disease was uterine fibroids – 46 (75.4 %) patients; among malignant ones – uterine cancer – in 13 (52.0 %) and cervical cancer in 9 (36.0 %) patients. Diagnosis of PM was based on an analysis of clinical manifestations, laboratory, and instrumental examination methods. Surgical treatment of patients was performed in three stages. In the first stage, all women admitted to the urology department were operated on: 62 (65.3 %) underwent surgical interventions using endourological methods, percutaneous puncture nephrostomy was performed in 28 (29.4 %), and ureteroneocystostomy was performed through an open surgical approach in 5 (5.3 %). In the second and third stages, after a control examination, surgical treatment was performed only in patients whose urodynamics had not been restored during the previous stage of treatment. Long-term treatment outcomes in patients treated using endourological methods were assessed 1–1.5 years after completion of specialized treatment based on the results of a comprehensive examination, including an assessment of urodynamics and the functional state of the kidney on the side of the operation.
Results. Throughout the treatment period, endoscopic surgical methods for the treatment of PM demonstrated high efficacy. In 55 (88.7 %) of 62 patients, endourological methods were used exclusively as first-line treatment at the date of admission to the urology hospital and subsequently. Of these (n = 55), good long-term results were noted in 48 (87.3 %), satisfactory – in 7 (12.7 %). The use of endourological methods was most effective in patients with short ureteral strictures. With a stricture length of up to 5 mm (n = 43), a good final result was obtained in 40 (93.0 %), satisfactory – in 3 (7.0 %); with a length from 5 to 10 mm (n = 9) – good – in 8 (88.9 %), satisfactory – in 1 (11.1 %); with a length from 10 to 20 mm (n = 3), only satisfactory results were achieved in all patients (100.0 %).
Conclusion. The obtained data demonstrate the high efficacy and practical feasibility of using minimally invasive endoscopic procedures in patients with ureteral strictures diagnosed after obstetric and gynecological surgery. The best results are achieved in patients with strictures up to 10 mm in length.

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