Analysis of 136 ureteral injuries in gynecological and obstetrical surgery from completed insurance claims.

OBJECTIVE Iatrogenic ureteral injury during pelvic surgical procedures is a well-known complication and important cause of morbidity. The authors investigated the circumstances surrounding registered ureteral injuries in order to identify potential opportunities to prevent such injuries. DESIGN Evaluation of claims concerning ureteral injuries reported to the Danish Patient Insurance Association. SETTING Danish Patient Insurance Association. SAMPLE All registered claims for ureteral injuries from 1996 to 2006. METHODS Retrospective study of medical records and data from Danish Patient Insurance Association. MAIN OUTCOME MEASURES Preventable ureteral injuries. RESULTS From 1996 to 2006, 136 submitted claims concerning ureteral injuries were registered. Among these, 73 claims were approved (54%), and compensation paid. In 44 of these, the injury was caused by negligence. Failure to dissect the ureter despite indications for this procedure was the most common type of negligence. Laparotomy procedures were associated with 107 injuries (79%) and 29 injuries (21%) were caused during laparoscopic procedures. Thirty-four patients suffered from chronic renal dysfunction on the affected side. Only 17 of the ureteral injuries were discovered during the procedure. CONCLUSIONS Forty-four ureteral injuries could potentially have been avoided using established surgical practices, most importantly by exposing the ureter via dissection when indicated. Most of the ureteral injuries were discovered postoperatively.