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Ureteral surgery performed by a university gynecologic oncology service.

Hoffman MS, Tebes SJ

University of South Florida, Division of Gynecologic Oncology, Tampa, FL, USA. macevedo@hsc.usf.edu

OBJECTIVE: The purpose of this study is to describe the incidence and types of ureteral surgical procedures that are necessitated during the course of surgical treatment of a population of patients who are cared for by a gynecologic oncology training program. STUDY DESIGN: From 1997 through 2004, the University of South Florida Division of Gynecologic Oncology database was accessed to extract the specifics of ureteral surgery that had been done during the course of the fellowship training program. RESULTS: Forty-six of 4844 major operations included ureteral surgery. Thirty of 46 procedures were repair of injury; all were recognized intraoperatively. The method of repair was simple closure (1 procedure), ureteroureterostomy (7 procedures), or direct ureteroneocystostomy (22 procedures). Two of the 7 ureteroureterostomies strictured. Ureteral resection was done for gynecologic malignancy in 15 of 16 patients. All 16 patients underwent reconstruction with direct ureteroneocystostomy. Seven of 16 patients underwent concomitant rectosigmoid colectomy. One of 16 patients who underwent en-bloc partial cystectomy had a postoperative vesicovaginal fistula. All 36 ureteroneocystostomies with short-term follow-up had radiologically normal upper urinary tracts. Eighteen patients had subsequent follow-up evaluations; all of them had radiologically normal upper urinary tracts at 5 to 42 months (mean, 19 months). CONCLUSION: When significant injury to the pelvic ureter occurs during radical pelvic surgery, ureteroneocystostomy may be the repair of choice. After resection of a portion of the pelvic ureter for gynecologic malignancy, the urinary tract was reconstructed successfully with direct ureteroneocystostomy. In those patients who underwent ureteral resection for malignancy, the extent of the disease process necessitated concomitant rectosigmoid colectomy 47% of the time.

Published 7 August 2006 in Am J Obstet Gynecol, 195(2): 562-6; discussion 566-7.
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