CAN PRE-OPERATIVE URETERIC STENTING PREVENT URETERIC INJURY IN WOMEN UNDERGOING DIFFERENT GYNECOLOGICAL SURGERY
DOI:
https://doi.org/10.71000/jm3ybc70Keywords:
Gynecologic Surgical Procedures, Intraoperative Complications, , Preventive Medicine, Risk Assessment, Stents, Ureteral Injuries, Observational Study.Abstract
Background: Iatrogenic ureteric injury is a serious complication of gynecological surgery, potentially leading to significant morbidity. The utility of prophylactic double-J (DJ) ureteral stenting as a preventive strategy remains a subject of ongoing clinical debate.
Objective: To observe the rate of ureteric injury and assess whether selective prophylactic DJ stent placement in high-risk patients contributes to its prevention.
Methods: A descriptive observational study was conducted over six months. A total of 225 patients undergoing elective gynecological surgery were enrolled. Prophylactic DJ stenting was performed in 21 patients deemed high-risk by the operating consultant. All procedures were performed by experienced consultants. Ureteric injury was monitored intraoperatively.
Results: The overall ureteric injury rate was 1.78% (4/225). The injury rate was 0% (0/21) in the stented group compared to 1.96% (4/204) in the non-stented group. All injuries occurred in the non-stented cohort during procedures for large fibroids (6.25%, 1/16), malignancy (4.88%, 2/41), and in cases with a history of chemo/radiotherapy (1.92%, 1/52).
Conclusion: Selective prophylactic ureteral stenting in high-risk gynecological surgeries was associated with a zero incidence of ureteric injury in this cohort, supporting its judicious use based on preoperative risk assessment.
References
Vodegel EV, Guler Z, Ras L, Mackova K, Groeneveld A, Bezuidenhout D, et al. Vaginal changes after ovariectomy in ewes: A large animal model for genitourinary syndrome of menopause. Int J Gynaecol Obstet. 2023;162(3):1042-9.
Leon MG, Guha P, Lewis G, Heckman M, Siddiqui H, Chen A. Use of prophylactic ureteral stents in gynecologic surgery. Minerva obstetrics and gynecology. 2023.
Ravlo M, Moen MH, Bukholm IRK, Lieng M, Vanky E. Ureteric injuries during hysterectomy-A Norwegian retrospective study of occurrence and claims for compensation over an 11-year period. Acta Obstet Gynecol Scand. 2022;101(1):68-76.
Wei G, Harley F, O'Callaghan M, Adshead J, Hennessey D, Kinnear N. Systematic review of urological injury during caesarean section and hysterectomy. Int Urogynecol J. 2023;34(2):371-89.
Masood L, Khan ZA, Ahmad MS, Rana AI, Ali H. Saving The Uterus; Our Experience In Uterine Artery Embolization For Acquired Uterine Vascular Abnormalities. J Ayub Med Coll Abbottabad. 2022;34(Suppl 1)(4):S913-s8.
Hu Y, Feng T. Recurrence complicated with peritoneal dissemination after single-port gasless myomectomy for cellular uterine leiomyoma: A case report and literature review. Medicine (Baltimore). 2024;103(11):e37444.
Gurumurthy M, McGee A, Saraswat L. Prophylactic ureteric catheterisation during complex gynaecological surgery: A systematic review and meta-analysis. BJOG : an international journal of obstetrics and gynaecology. 2024.
Scaglione M, Allshouse A, Canfield D, McLaughlin H, Bruno A, Hammad I, et al. Prophylactic Ureteral Stent Placement and Urinary Injury During Hysterectomy for Placenta Accreta Spectrum. Obstetrics & Gynecology. 2022;140:806-11.
Tabourin T, Sarfati J, Pinar U, Beaud N, Parra J, Vaessen C, et al. Postoperative assessment of nosocomial transmission of COVID-19 after robotic surgical procedures during the pandemic. Urol Oncol. 2021;39(5):298.e7-.e11.
Hsu CS, Lu CM, Kow JY. Laparoscopic modified simple ureteroneocystomy in iatrogenic lower third ureter injury during gynecology surgery. Taiwan J Obstet Gynecol. 2024;63(5):777-80.
Kriplani I, Kriplani A, Sharma S, Sodhi M, Jain N. Laparoscopic Management of Disseminated Peritoneal Leiomyomatosis. J Minim Invasive Gynecol. 2023;30(6):443-4.
Cebeci O. Is endourological intervention a suitable treatment option in the management of iatrogenic thermal ureteral injury? A contemporary case series. BMC Urol. 2022;22(1):137.
Bettaiah R, Konda KR, M SN, S A, S P, Das P. Intraperitoneal Iatrogenic Fibroid after Laparoscopic Myomectomy Displacing the Retroperitoneal Structures. J Minim Invasive Gynecol. 2023;30(8):603-5.
Thong EP, Hart RJ, Teede HJ, Vincent AJ, Enticott JC. Increased mortality and non-cancer morbidity risk may be associated with early menopause and varies with aetiology: An exploratory population-based study using data-linkage. Maturitas. 2022;164:60-6.
Yanagisawa T, Mori K, Quhal F, Kawada T, Mostafaei H, Laukhtina E, et al. Iatrogenic ureteric injury during abdominal or pelvic surgery: a meta-analysis. BJU Int. 2023;131(5):540-52.
Rosa ESJC, Ribeiro PA, Brito LGO, Gomes MTV, Podgaec S, Ribeiro H, et al. Gynecological Surgery and COVID-19: What is the Impact and How Should I Manage it? Rev Bras Ginecol Obstet. 2020;42(7):415-9.
Hampel C. [Functional disorders of the lower urinary tract following urogynecologic and abdominal surgery]. Urologie. 2025;64(2):136-41.
Bakshi N, Dhawan S. Extrapelvic "Uterus Like Mass" Following Laparoscopic Morcellation Hysterectomy - a Consequence of Iatrogenic Implantation? Int J Surg Pathol. 2023;31(5):791-4.
Soleymani Majd H, Yancheva S, Abdul B, Hellner K. Emergency hysterectomy following iatrogenic injury to the descending branch of the uterine artery during colposcopy. BMJ Case Rep. 2023;16(12).
Benito V, Lubrano A, León L, Molano F, Pinar B. Does iatrogenic tumor rupture during surgery have prognostic implications for the outcome of uterine sarcomas? Int J Gynecol Cancer. 2020;30(11):1726-32.
Neamtu R, Dahma G, Mocanu AG, Bernad E, Silaghi CI, Stelea L, et al. Challenges in Diagnosis and Prevention of Iatrogenic Endometriosis as a Long-Term Surgical Complication after C-Section. Int J Environ Res Public Health. 2022;19(5).
McCarus S, Alexandre A, Kimura T, Feng Q, Han W, Shortridge E, et al. Abdominopelvic Surgery: Intraoperative Ureteral Injury and Prophylaxis in the United States, 2015–2019. Advances in Therapy. 2023;40:3169-85.
Ali MA, Maalman RS, Oyortey MA, Donkor YO, Adanu KK, Tampuori J, et al. A 6-year retrospective clinical review of iatrogenic ureteric injuries repaired in a resource-deprived setting. BMC Surg. 2022;22(1):380.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Barkha, Shazia Naseeb (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
