Clinical analysis and treatment of ureteral injury caused by laparoscopic surgery in patients with locally advanced cervical cancer

Objective To investigate the causes, precautions, and treatment of ureteral injury associated with laparoscopic radical surgery for locally advanced cervical cancer. Methods The clinical data of patients with locally advanced cervical cancer suffering from ureteral injury occurred during or after laparoscopic radical hysterectomy and pelvic lymphadenectomy performed at our hospital between January 2014 and December 2018 were retrospectively analyzed. Results Totally, fifty-four patients with locally advanced cervical cancer underwent laparoscopic radical surgery. Intraoperative ureteral injury occurred in one woman, for whom laparoscopic ureteral end-to-end anastomosis and stent implantation were performed immediately. Postoperative hydroureter was observed in eight patients and treated by ureteral stent implantation under ureteroscopy. There were four cases of postoperative ureteral fistula: one patient with bilateral ureteral fistula was, after failing in placing bilateral ureteral stents under ureteroscopy, subjected to laparotomy for stent implantation into the left ureter and end-to-end anastomosis of the right ureter; one patient with right ureteral fistula underwent ureteroscopic ureteral stenting; one patient with left ureteral fistula received a laparotomic ureteroplasty with bladder wall flap; another patient with right ureteral fistula who had symptoms of leaking urine 14 days after surgery, but sought treatment until one month after surgery, underwent percutaneous nephrostomy after a failed ureteral intubation, followed by a ureterovesical replantation after six months. All patients who had received ureteral catheterization underwent extraction of ureteral stents after three to six months and recovered well. Conclusions The radical surgery for locally advanced cervical cancer requires an extensive surgical procedure because of the bulky size of the lesion, which is associated with an increased risk of ureteral injury. With early detection and proper treatment, a good prognosis of the ureteral injury can be expected. Key words: Uterine cervical neoplasms; Laparoscopy; Operative complications; Ureteral injury