Which surgical procedure has the highest incidence of ureteric injury :
Weheim's hysterectomy Because of the close anatomical association between ureter and Genital organs, ureteric injury is not uncommon during Gynaecological surgery. "About 75% of Ureteral injuries result from Gynaecological operations and 75% of them occur following abdominal Gynaecological procedures." From the above lines it is clear that, k abdominal operations, ureters are more prone to injury than in vaginal operations (ruling out Options "a" and "d-). Friends amongst the remaining two options Viz- Abdominal hysterectomy and Weheims Hysterectomy (also done by abdominal route). Logically speaking Weheim's Hysterectomy carries more risk of Ureter injury which means (not just cutting of Ureter but also includes ligation and devasculirization of ureters) because of 2 reasons : Weheim's is done in case of carcinomas and therefore lots of adhesions are present during surgery In Weheims - medial half of cardinal ligament is cut. Now if you remember the position of ureter. (See diag below). * Ureters are very prone to injury during cutting of medial half of cardinal ligaments. To suppo the above logic CGDT 10/e, p 779 says : "The repoed incidence of ureteral injury during Gynaecologic 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 Weheim's Radical Hysterectomies." Extra Edge : Impoant Anatomical locations where ureteric injury is common - At the level of infundibulo - pelvic ligaments.deg - Below the level of ischial spine.deg - At the level of internal cervical os - where uterine aery crosses the ureter frOM aOove.deg -Over the Anterior vaginal Fornix when ureter crosses it to enter the trigone of bladder. Urethra is prone to injury durinduring_*Anterior Colporrhaphydeg
Vaginal hysterectomy
Abdominal hysterectomy
Weheim's hysterectomy
Anterior colporrhaphy