Date Published: April 24, 2018
Author(s): Anthony Wanjala, Henry Mwangi, Hillary Mabeya.
Ureteric pathology arises from surgical misadventures, trauma, and congenital anomalies. Early detection and treatment is of the essence.
To determine the types/etiology and outcome of ureteric pathology presenting to Gynocare Fistula Centre, Eldoret, Kenya.
Descriptive retrospective study that evaluated patients presenting with ureteric pathology at Gynocare between 1st January 2012 and 31st December 2016. We pulled out patient charts and extracted and analyzed relevant data using STATA 13E statistical software.
We analyzed 33 charts, and their age ranged from 10 to 58 years. Annual proportion for 2012, 2013, 2014, 2015, and 2016 was 2.5%, 2.8%, 1.2%, 1.4%, and 3.0% respectively among all the fistula patients treated in the hospital. All the patients presented with urinary incontinence, and 7 (21.2%) had flank pain. Iatrogenic injuries contributed 84.8% (28), and 3 (9.1%) were congenital while trauma and infection had 1 each. Of those resulting from surgical misadventures, 17 (60.7%) were from obstetric while 11 (39.2%) were from gynecological surgery. All the injuries were in the distal third of the ureter; 5 were bilateral; and 11 were left sided while 17 were right-sided. Repair and/or reimplantation was successful in 31 (93.93%) of the patients.
Highest proportion of ureteric pathologies was accounted for by iatrogenic causes and surgical repair and/or reimplantation has a high success rate.
Ureteric pathology may arise from abdominal and pelvic surgery, trauma, congenital anomalies, malignancies, and radiation. Iatrogenic causes, though rare, account for most of the ureteric pathology . The location of the ureter in the retroperitoneal space and its close proximity to the pelvic reproductive organs make it susceptible to injury during surgery . Congenital anomalies of the ureter rarely occur alone and are likely to be accompanied by other anomalies on the urinary tree .
This was a descriptive retrospective study that evaluated all patients who presented with ureteric pathology at Gynocare Fistula Centre from 1st January 2012 to 31st December 2016. Located in Eldoret town on the Western part of Kenya, Gynocare is the biggest fistula referral centre in Kenya, with a bed capacity of 74. Every year the hospital performs over 300 fistula-related surgeries and manages many others conservatively. In 2014, the centre was accredited by WHO (World Health Organization) through FIGO (International Federation of Gynecology and Obstetrics) to train upcoming fistula surgeons. Since then, a total of 7 surgeons have been trained and certified while many others have visited to gain experience in specific areas.
Ureteric pathology can lead to serious morbidity and mortality if not detected early and treated. Among the leading causes of this is inadvertent ureteric injury during surgery [8, 9].
Iatrogenic injury is the commonest cause of ureteric pathology, from either obstetric or gynecological surgeries. The close association between reproductive organs and the ureter makes it more liable to injury. Surgical intervention has a high success rate.