A six-year retrospective clinical review of iatrogenic injuries repaired in a resource- deprived setting

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Abstract Introduction: Ureteric injuries resulting from iatrogenic causes is over 70% with about 75% of these cases diagnosed in the post-operative period with complications that increase morbidity and treatment cost.Objective: The purpose of the study is to identify risk factors for iatrogenic ureteric injuries(IUI) from open surgical procedures and the clinical outcome of interventions. Patients and methods: Clinical records of patients with IUI between 2015-2021 who were repaired at the urology units, MMCH and HTH were retrieved. Important data extracted included patients' demographics, clinical presentation, primary surgery details, time from surgery to injury types of ureteric injury, complications, and interventional outcomes data were extracted and analysed using the Statistical package for social scientists (SPSS version 24). Results: Twelve patients with 19-injuries aged between 24 - 54 years were treated. Injuries resulting from hysterectomy 83.3%, Caesarean section, and hernia repairs resulted in other 16.7%. Most were post-operative diagnoses after 48-hours(7/12). Bilateral injuries occurred in 7 cases(14/19 injuries) performed entirely by non-surgeon clinicians. Intra-operative recognition was related to unilateral damage and surgeries performed by surgeons. Ureteroneocystostomy(14/19), uretero-ureterostomy(1/19), and open suture release were the proceduresDiscussion: Open hysterectomy(83.7%) was the single surgery with many IUI. Outcome indicators related to major presenting complications, frequency, bilateral and late recognition of injuries, were those performed by general physicians on mostly elective cases. This pattern is a pre-operative predictive factor of the worst IUI occurrence.Conclusion:Mishaps during hysterectomies by none-surgeon clinicians are the single dangerous risk factor for complicated open surgery IUIs in the Volta region.

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