Ureteric injuries in Enugu, Nigeria

Objective: To study the aetiology, mode of presentation and treatment outcome of ureteric injuries in Enugu, Design: A prospective study carried out between January 1986 and December 1997, Setting: Three busy health institutions in Enugu, Nigeria, namely, University of Nigeria Teaching Hospital, Mother of Christ Specialist Hospital and JAMA Urological Clinic. Subjects: All patients presenting with ureteric. injuries during the study period, Interventions: Exploration and reconstruction of the injured ureter. Main outcome measures: Intravenous urography three months post operatively, Results: One hundred and forty eight patients were treated, out of which fifteen had bilateral injuries, All the injuries except one, occurred during operations for various abdominal and pelvic conditions, Fifteen males(10.1%) and 133 females (89.9%) were involved, Gynaecological operations accounted for majority of cases(87.8%), The type of injury was either transection or ligation, The left ureter was injured more than the right (52.1% and 47.9%, respectively), In 71 patients (48.0%), there was a fistula between the injured ureter and the vagina, presenting clinically with urinary incontinence. In 39 patients (26.4%), the injuries were discovered at surgery while the rest presented after the offending surgery. Ureteroneocystostomy, end-to-end ureteric anastomosis, and ileal interposition were the reconstructive methods adopted. Ail the renal units were salvaged and all the patients survived the procedures, however, post-operative IVU in four patients showed ureteric reflux. Conclusion: Open gynaecological operations are still the leading cause of ureteric injuries in Nigeria.