Iatrogenic ureteric injuries in a Nigerian Teaching Hospital- experience in the last decade

Abstract

Background: Ureteric injury is one of the most serious complications of any abdominal or pelvic surgery with significant morbidity. The medico-legal consequences are also becoming areas of concern in our environment. Traditionally abdominal hysterectomy was responsible for most cases. While recent reports from the west have however indicated a change in the pattern of these iatrogenic injuries with urological endoscopy being the major source, recent literature from the sub-Saharan Africa is relatively sparse, with the few ones available also indicating a change in pattern however of a different variety with a high incidence of injuries arising from gynaecological, non-hysterectomy causes. Objectives: To determine the incidence, pattern of presentation and outcome managements of iatrogenic ureteric injuries in our centre. Design: A retrospective descriptive study. Setting: Lagos University Teaching Hospital, Lagos, Nigeria. Subjects: Twenty patients managed for iatrogenic ureteric injuries between January 2000 and June 2010. Results: A total of 20 patients were managed for 24 iatrogenic injuries. Total abdominal hysterectomy was responsible for 15 (75%) of the patients. Six patients had the injury from the referring hospital in four of whom the gynaecological operations were performed by general practitioners (GP). Twelve patients developed injury after operation in our centre. Excessive intra-operative bleeding and emergency surgery in critically ill patients referred by the GP or traditional birth attendants were the most common predisposing factors. All but one patient had open surgical intervention. All patients with delayed diagnosis were operated immediately they were fit for anaesthesia irrespective of the time of injury. Outcome was satisfactory in all patients who had surgical intervention. There was one mortality whic h occurred in one patient who presented late and died before surgical intervention. Conclusion: Total abdominal hysterectomy still accounts for most cases of iatrogenic ureteric injuries in our environment. Open surgical intervention gives satisfactory results in all cases. Early surgical intervention is necessary to prevent morbidity and mortality.