Ureteric Injury During Gynaecological Surgery – Lessons from 20 Cases in Canada

BACKGROUND: Ureteric injury is a complication of gynaecological surgery that can cause significant morbidity for the patient and is a leading cause of litigation in many countries. OBJECTIVES: To determine patient characteristics, peri-operative circumstances and clinical and legal outcomes of ureteral injuries associated with gynaecological surgery. PATIENTS AND METHODS: This is a retrospective review of 20 cases of ureteric injury during benign gynaecological surgery. MAIN OUTCOME MEASURES: All cases were assessed for the following variables–patient characteristics, indications for surgery, injury, postoperative symptoms and presentation, and clinical and legal outcomes. RESULTS: Risk factors associated with ureteric injury included obesity, previous laparotomic pelvic surgery, pelvic adhesions, large pelvic masses and intra-operative bleeding. 70% (14/20) of ureteral injuries were diagnosed after discharge. 50% (10/20) of patients had a complicated post-operative course and 45% (9/20) of cases resulted in unfavourable legal outcomes (settlement or lost at trial) for the surgeon. The conduct of surgery and the failure to act in a timely fashion postoperatively were the most frequent reasons for adverse clinical and unfavourable litigation outcomes for the surgeon. CONCLUSIONS: Intra-operative surgical consultation and ureteral identification should be considered if there is concern for ureteral involvement in the surgical field. Ureteric injury may not constitute negligence if it is demonstrated that the surgeon provided reasonable care that would be expected during the peri-operative phases. WHAT IS NEW: This review identifies patient characteristics and peri-operative variables that correlate with poor clinical and legal outcomes after ureteric injury.