Maximum chances of ureteric injury are with:
Ans. is b, i.e. Wertheims hysterectomyRef: COGDT 10th/ed, p779; Dutta Gynae 5th/ed, p408Since in Wertheims hysterectomy, we are removing the medial half of cardinal ligament, there are maximum chances of injuring the ureter and furthermore wertheims hysterectomy is done is case of cancers and a lot of adhesions are present during surgery which increases the chances of ureteric injury* Ureters are very prone to injury during cutting of medial half of cardinal ligaments."About 75% of ureteral injuries result from Gynecological operations and 75% of them occur following abdominal Gynecological procedures" - Dutta 5th/ed, p408* From the above lines it is clear that, in abdominal operations, ureters are more prone to injury than in vaginal operations (ruling out Options "c" and "d")"The reported incidence of ureteral injury during Gynecologic procedures ranges from about 0.5% in simple hysterectomies for benign disease upto 1.6% for laparoscopic cases and to as high as 30% for some older series of Wertheim's Radical Hysterectomies." - CGDT 10th/ed, p779Also KnowPiver Rutledge classification of types of hysterectomyType ITotal Abdominal HysterectomyType IIWertheims hysterectomyType IIIRadical hysterectomy/Meigs hysterectomyType IVExtended radical hysterectomyType VComplete pelvic extenteration
TAH
Wertheim's hysterectomy
Anterior colporrhaphy
Vaginal hysterectomy
Gynaecological Diagnosis