抄録
Background: Total laparoscopic hysterectomy (TLH) has become popular for total hysterectomy in recent years. However, the procedure has higher incidence of ureteral injury as compared with abdominal total hysterectomy (ATH). Assessing for hydronephrosis is a useful method of checking for ureteric injury in postoperative follow-up.
Subjects/Methods: The 165 cases of TLH performed at this institution between 2009 and 2014 were retrospectively examined. We investigated the proportion of cases in which late-onset hydronephrosis manifested in the postoperative follow-up period, the surgical findings and clinical course of those cases.
Results: Of the 165 cases, hydronephrosis were observed in three cases (1.8%) during the follow-up period. all of three cases, severe adhesions made with difficulty to identify the ureter in the anterior approach. Hydronephrosis was diagnosed between postoperative days 47 and 82. Ureteral stent placement was performed in one case, the other two cases were observed with conservative follow-up. All of three cases, hydronephrosis have resolved between postoperative days 97 and 131.
Discussion: When severe adhesions necessitate the lateral or posterior approach to ureter identification, as in these cases, the requirement of dissection of periureteral tissue is more extensive as compared with anterior approach. It might be sought that more dissection made reduction of blood flow to the ureter and heat injury due to the energy devices, which could result in a hydronephrosis. In addition, if there is no damage to the ureter, cases of late-onset hydronephrosis may potentially be resolved with conservative management of ureter.
