Postoperative color Doppler sonography of the ureteral jets to detect ureteral patency in laparoscopic hysterectomy

Abstract

patient who had undergone laparoscopic hysterectomy. Material and Method: A prospective study was performed on 170 patients scheduled for laparoscopic hysterectomy. The operations were performed for benign gynecologic disease. All patients had pre-and post-operative color Doppler sonography of the ureteral jets to determine ureteral patency. Transabdominal color Doppler sonography was used to evaluate the presence or absence of the ureteral jets from both ureteric orifices. The time for detection of the first jet and the number of jets in five minutes were recorded separately for each side. Preoperative assessment was used as control. Statistical analysis was performed by using Wilcoxon signed ranks test, considering p < 0.05 as significant. If there was absence of the ureteral jet on one or both sides, the patient was sent to repeat color Doppler sonography on the next day. Intravenous pyelography was performed to confirm ureteral injuries when the repeat examination was still found abnormal. Results: Bilateral ureteral jets were demonstrated by color Doppler sonography in 168 of the 170 patients. In two patients, postoperative examination demonstrated the absence of the ureteral jet on the left side. Intravenous pyelography was performed and confirmed left ureteral obstruction. They underwent left ureteroneocystostomy. In 168 patients, bilateral ureteral jets were demonstrated in either preoperative or postoperative examination. The time for detection of the first jet was not significantly different between preoperative and postoperative examination of either the right side (p = 0.189) or the left side (p = 0.694). The number of jets in five minutes was not significantly different between preoperative and postoperative examination of either the right side (p = 0.854) or the left side (p = 0.675). Conclusion: Color Doppler sonography is a simple and reliable technique that may be used to evaluate ureteral jets into the bladder in patients who underwent laparoscopic hysterectomy. The time for detection of the first jet and the number of jets in five minutes are not affected by the postoperative status. The presented test may be a good screening test to detect ureteral injuries following laparoscopic hysterectomy.