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Gynaecology & Obstetrics Operative Obs a36604ee

Which procedure has the highest incidence of ureteric injury:

A
Abdominal hysterectomy
B
Vaginal hysterectomy
C
Wertheim's hysterectomy
D
Adnexectomy
High-Yield Explanation
Ans. C. Wertheim's hysterectomyThe incidence of ureteral injury has increased during the past four to five decades since removal of the uterine cervix has become a standard procedure with abdominal hysterectomy.Removal of the cervix is the riskiest part of the total abdominal hysterectomy procedure because most injuries occur in the lowest 3cm of ureter just above the bladder.Gynecologic Procedures Associated with Ureteral InjuryOperative ProcedureIncidence of Ureteral Injury (%)Abdominal hysterectomy0.5-1.0Vaginal hysterectomy0.1Extensive Wertheim Hysterectomy1.0-2.0Adnexectomy0.1Marshall-Marchetti-Krantz procedure<0.1

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