Sources: Danish Medical Journal -Acta Obstetricia et Gynecologica; MEDLINE; Years of Medical Malpractice Litigation Experience with Women’s Health Issues
URETERAL injury is one of the most serious complications of obstetric and gynecologic surgery. Injuries to the urinary tract, particularly the ureter, are the most common cause for legal action against obstetric and gynecologic surgeons.
Iatrogenic (doctor-caused) ureteral injury during obstetrical and gynecologic surgery may be found during the surgery or postoperatively. If it is recognized immediately, consultation with a urologist can result in primary ureteral repair in the same operation. However, cuting or stitching or kinking the ureter is more often not recognized immediately. More than 70% of the time, ureteral injury is only noticed postoperatively. Symptoms in the postoperative period include: flank pain; prolonged ileus (delayed bowel movement); fever; watery vaginal discharge; or elevated serum creatinine levels. In cases of bilateral ureteral injury, anuria (not being able to urinate) is the first clinical sign.
Due to the close anatomical relationship between the female reproductive organs and the ureter, when a ureteral injury does occur, quick recognition of the problem and a working knowledge of its location and treatment are critical in determining how well a repair might work.
A significant ureteral injury is medically any recognized or unrecognized iatrogenic (doctor-caused) trauma to the ureter that prevents the ureter from functioning properly or effectively. The frequency of ureteral injury following gynecologic surgery (ie. c-section or fibroid removal) is approximately 1%, with a higher percentage of injuries occurring during hysterectomy. The rate of ureteral injuries in laparoscopic procedures varies with the skill and experience of the doctor performing the surgery. Some physicians report that laparoscopic procedures have an equivalent rate of ureteral stricture formation secondary to ureteral injury. Abstracts and studies of this issue seem to indicate that the rate of ureteral strictures is significantly higher than reported.
The 6 most common mechanisms of operative ureteral injury are as follows:
Crushing from misapplication of a clamp
Ligation with a suture (stitch)
Transsection (cutting) partial or complete
Angulation of the ureter with secondary obstruction
Ischemia from ureteral stripping or electrocoagulation
Resection of a segment of ureter
Any combination of these injuries may occur. There are some factors which make ureteral injury more likely. Among these are: a uterus size larger than 12 weeks’ gestation; ovarian cysts -4 cm or larger; endometriosis; pelvic inflammatory disease; prior intra-abdominal operation; scarring or adhesions; radiation therapy; advanced stages of cancer; and, anatomical anomalies of the urinary tract. While injuries to the bladder or rectum are more common, ureteral injuries are far more serious and troublesome and are often associated with significant and long-term symptoms such as: chronic urinary difficulty; chronic urinary tract infection; chronic ureteral obstruction; crush injuy; pelvic pain; the formation of ureterovaginal fistulas; the potential loss of kidney function; sexual dysfunction and avoidance; and, the need for more surgeries.
For women who live with a ureteral injury and their loved ones, the late recognition and delayed treatment of ureteral injuries often leads to a long period of pain and suffering which interrupts their lives in significant ways, at best. In the worst case scenario, the delayed repair of a ureteral injury may lead to botched repairs or the inability to repair and the loss of kidney function with requirement for stenting and catheterization or complete external bypass of the urinary tract.
The Lewis Law Firm has a history of representing women who have sustained ureteral injuries from improperly performed obsetric and gynecologic surgery. If you or your loved one has suffered a ureteral or other injury following c-section, hysterectomy or fibroid surgery, contact the Lewis Law Firm for a Free consultation and case review, today.