Abstract
INTRODUCTION: Ureteral injuries during gynecologic surgery are uncommon (0.1%-2.5%) but may result in significant morbidity, including strictures, hydronephrosis and the need for additional interventions. This study evaluates the effectiveness of retrograde endoscopic management in treating iatrogenic ureteral injuries. MATERIALS AND METHODS: A retrospective review was conducted on women diagnosed with ureteral injury post-gynecologic surgery between 2010 and 2024 at a single institution. Patients were categorized into two groups: those treated with retrograde endoscopic interventions and those managed with non-endoscopic approaches (percutaneous nephrostomy and/or surgical reconstruction). The endoscopic group was further divided into early (<3 months post-injury) and late interventions. Outcomes assessed at ≥3 months of follow-up included treatment success, long-term complications and the need for further interventions. RESULTS: Of 42 patients, 29 (69%) underwent endoscopic treatment and 13 (31%) received non-endoscopic management. Among endoscopically treated patients, early intervention achieved an 80% success rate, significantly higher than the 33% observed with late intervention (p = 0.03). All non-endoscopic patients initially received percutaneous nephrostomy, and 12 (92.3%) required definitive surgical repair. Endoscopic treatment was associated with reduced operative time and shorter hospital stays. Given the rarity of ureteral injuries, the cohort represents one of the largest single-centre experiences focused on this specific population. CONCLUSIONS: Early retrograde endoscopic management is a safe and effective approach for treating ureteral injuries after gynecologic surgery. Timely diagnosis and intervention significantly improve outcomes. Non-endoscopic patients were more complex cases, often unsuitable for endoscopy, which may account for outcome differences. Intraoperative retrograde ureterography and stenting should be considered whenever there is suspicion of ureteric injury, whereas postoperative endoscopic realignment or endoscopic management of ureteric strictures should be performed by appropriately trained urologists. Further prospective studies with larger cohorts and longer follow-up are warranted to refine optimal clinical pathways and long-term management strategies.