Table III.
Ureteral injuries associated with total abdominal hysterectomy +/- oophorectomy (BMI- body mass index, NA- Not available, AUB-Abnormal uterine bleeding, POD- Post operative day, TAH- Total abdominal hysterectomy, LSO- Left salpingo- oophorectomy, RSO- Right salpingo-oophorectomy, BSO- Bilateral salpingo-oophorectomy, IVP- Intravenous pyelography, US- Ultrasound, CPP- Chronic pelvic pain, HTN- hypertension.
| Case/Year | Age/Parity | BMI | Comorbidity | Indication for surgery | Surgery | Presentation | Investigation/Intervention | Legal outcome |
|---|---|---|---|---|---|---|---|---|
| 12/2003 | 43 | 35 | Obesity | AUB, Large fibroid uterus | TAH 3 hours. Significant bleeding sutured. Ureters- good peristalsis | POD #1: Asymptomatic. US to exclude suspected injury-Rt hydrone-phrosis, ureteral obstruction | POD #1: Percutaneous nephrostomy. 3 months: Laparotomy- reimplantation | Trial-won by Defendant |
| 13/1991 | 53 | 40 | Obesity, Hysteropexy, Appendectomy, LSO | AUB, Cervical dysplasia | TAH+RSO. Difficult adhesiolysis | POD #0: Oliguria, urine per vagina | POD #0: IVP-Cystotomy, left ureteral obstruction. POD #1: Laparotomy: Bladder repair, ureteral reimplantation. POD #2: Pulmonary embolism, death | Trial-won by defendant |
| 14//1995 | 47/ G2P1 |
NA | None | AUB | TAH-BSO. Ureters identified at pelvic brim | POD #1-3: Fever -38.5° C x 2,HTN | POD #42: no issues POD #75: US-Right hydronephrosis. Nephrostomy-failed to recover kidney function. Nephrectomy | Dismissed. Renal failure, likely to pre-existing HTN |
| 15/2000 | 47 G1P1 |
NA | Caesarian section, HTN, Migraines | AUB Fibroid uterus | TAH-BSO. Ureters identified at pelvic brim. Bleeding sutured left vaginal vault. | POD #38: Left loin pain | POD#45: IVP/CT/cystoscopy/retrograde pyelography-Lt ureteral obstruction, urine extravasation. Percutaneous nephrostomy Laparotomy: Reimplantation | Dismissed |
| 16/2004 | 36 | NA | Endometriosis Fibroid uterus | AUB Uterine fibroids CPP | TAH-BSO Intraoperative: Left ureteral injury repaired by ureteroneo-cystotomy | POD #5: Intermittent back pain. POD #6: discharged | POD #35: IVP: Right hydronephrosis, hydroureter. Left ureter-normal Percutaneous nephrostomy Laparotomy: Reimplantation with Boari flap | Settlement |