The journal of obstetrics and gynaecology research · 2025
Prediction of Periureteral Adhesions by Drop Infusion Pyelography Before Laparoscopic Hysterectomy: A Retrospective Study.
СтатьяНазвание и аннотация: Перевод в очереди
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Azuma Yukihiro, Fujioka Rina, Yamamoto Koji, Matsumoto Mei, Nagata Hiroki, Wada Ikumi, Moriyama Maako, Komatsu Hiroaki, Taniguchi Fuminori
Аннотация
AIM: To identify the predictors for periureteral adhesions preoperatively.
METHODS: Preoperative predictors for periureteral adhesions were evaluated in 407 patients who underwent laparoscopic hysterectomy (LH) for benign uterine diseases in our hospital between 2013 and 2022.
RESULTS: Periureteral adhesions were observed in 57 patients (14%). Multivariate analysis identified the following predictors for periureteral adhesions: endometriosis (odds ratio (OR), 8.54; 95% confidence interval (CI), 1.51-48.30; p < 0.05), obliteration of Douglas' pouch (OR, 89.50; 95% CI, 5.07-1580.03; p < 0.01), and ureteral flexion on drop infusion pyelography (DIP) (OR, 647.00; 95% CI, 63.00-6650.02; p < 0.001). Ureteral flexion on DIP diagnosed periureteral adhesion most accurately (sensitivity: 93.0%, specificity: 95.1%, accuracy: 94.8%). Operation time to complete LH was significantly longer in the adhesion group than in the non-adhesion group (162 min vs. 148 min; p < 0.01). Iatrogenic ureteral injury (IUI) was more common in the adhesion group than in the non-adhesion group (OR, 19.14; 95% CI, 1.51-1013.84; p < 0.01).
CONCLUSION: These results suggest that preoperative DIP is a useful predictor of periureteral adhesions. Preoperative preventive measures for IUI, such as ureteral stenting, are important in cases where severe adhesions are suspected.
METHODS: Preoperative predictors for periureteral adhesions were evaluated in 407 patients who underwent laparoscopic hysterectomy (LH) for benign uterine diseases in our hospital between 2013 and 2022.
RESULTS: Periureteral adhesions were observed in 57 patients (14%). Multivariate analysis identified the following predictors for periureteral adhesions: endometriosis (odds ratio (OR), 8.54; 95% confidence interval (CI), 1.51-48.30; p < 0.05), obliteration of Douglas' pouch (OR, 89.50; 95% CI, 5.07-1580.03; p < 0.01), and ureteral flexion on drop infusion pyelography (DIP) (OR, 647.00; 95% CI, 63.00-6650.02; p < 0.001). Ureteral flexion on DIP diagnosed periureteral adhesion most accurately (sensitivity: 93.0%, specificity: 95.1%, accuracy: 94.8%). Operation time to complete LH was significantly longer in the adhesion group than in the non-adhesion group (162 min vs. 148 min; p < 0.01). Iatrogenic ureteral injury (IUI) was more common in the adhesion group than in the non-adhesion group (OR, 19.14; 95% CI, 1.51-1013.84; p < 0.01).
CONCLUSION: These results suggest that preoperative DIP is a useful predictor of periureteral adhesions. Preoperative preventive measures for IUI, such as ureteral stenting, are important in cases where severe adhesions are suspected.