Original Articles

Post-Hysterectomy Transient Hydronephrosis: A Prospective Study


Objective: To determine the incidence and importance of transient asymptomatic hydronephrosis following total hysterectomy.
Materials and methods: In a prospective study over 4 year, 368 women were studied who had undergone a total abdominal or vaginal hysterectomy. Totally, 95% of operations were done for benign diseases (abnormal uterine bleeding, chronic pelvic pain, uterine prolapse, etc.) and 5% were performed for uterine malignancy. Renal ultrasonography was performed before and 3, 7 and 28 days after the surgery for diagnosing hydronephrosis. Intravenous urography was performed in patients with either persistent/progressive or symptomatic hydronephrosis.
Results: There was no intraoperative identifiable ureteral injury. Hydronephrosis was seen in 35 (9.5%), 21 (5.7%), and 1 (0.27%) patients at days 3, 7 and 28 after the operation, respectively. The degree of hydronephrosis was graded I, II or III. Considering the frequency and severity of hydronephrosis, the right kidney was affected more. Hydronephrosis correlated significantly with indication, duration and route of surgery as well as patient's age. All kidneys improved spontaneously, except one case which needed ureteral stenting with no surgical intervention (p=0.05).
Conclusion: Transient hydronephrosis could occur after simple total hysterectomy despite the absence of any obvious intraoperative ureteral injury. It is noted in 9.5% of the patients within three days after the non-complicated surgery. The clinical course may be continued until one month.

1. Berek JS. Berek& Novak's Gynecology. Sixteenth ed. Philadelphia: Wolters Kluwer; 2020.
2. Handa VL, Le LV. Te Lind's Operative Gynecology twelfth ed. Philadelphia: Wolters Kluwer; 2020.
3. Alan W Partin. Campbell Walsh Wein Urology . 12th Edition: elsevier; 2020.
4. Ou CS, Huang IA, Rowbotham R. Laparoscopic ureteroureteral anastomosis for repair of ureteral injury involving stricture. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16: 155-7.
5. Chan JK, Morrow J, Manetta A. Prevention of ureteral injuries in gynecologic surgery. Am J Obstet Gynecol 2003; 188: 1273-7.
6. Sharp HT, Adelman MR. Prevention, recognition, and management of urologic injuries during gynecologic surgery. Obstet Gynecol 2016; 127: 1085-96.
7. Manoucheri E, Cohen SL, Sandberg EM, Kibel AS, Einarsson J. Ureteral injury in laparoscopic gynecologic surgery. Rev Obstet Gynecol 2012; 5: 106-11.
8. Petersen SS, Doe S, Rubinfeld I, Davydova Y, Buekers T, Sangha R. Rate of urologic injury with robotic hysterectomy. J Minim Invasive Gynecol 2018; 25: 867-71.
9. Blackwell RH, Kirshenbaum EJ, Shah AS, Kuo PC, Gupta GN, Turk TMT. Complications of recognized and unrecognized iatrogenic ureteral injury at time of hysterectomy: A population based analysis. J Urol 2018; 199: 1540-5.
10. Barbic M, Telenta K, Noventa M, Blaganje M. Ureteral
injuries during different types of hysterecomy: A 7-year series at a single university center. Eur J Obstet Gynecol Reprod Biol 2018; 225: 1-4.
11. Kiran A, Hilton P, Cromwell DA. The risk of ureteric injury associated with hysterectomy: a 10‐year retrospective cohort study. BJOG 2016; 123: 1184-91.
12. Donnez O, Donnez J. A series of 400 laparoscopic hysterectomies for benign disease: a single centre, single surgeon prospective study of complications confirming previous retrospective study. BJOG 2010; 117: 752-5.
13. De Cicco C, Schonman R, Craessaerts M, Van Cleynenbreugel B, Ussia A, Koninckx PR. Laparoscopic management of ureteral lesions in gynecology. Fertil Steril 2009; 92: 1424-7.
14. Adelman MR, Bardsley TR, Sharp HT. Urinary tract injuries in laparoscopic hysterectomy: a systematic review. J Minim Invasive Gynecol 2014; 21: 558-66.
15. Léonard F, Fotso A, Borghese B, Chopin N, Foulot H, Chapron C. Ureteral complications from laparoscopic hysterectomy indicated for benign uterine pathologies: a 13-year experience in a continuous series of 1300 patients. Hum Reprod 2007; 22: 2006-11.
16. Soong YK, Yu HT, Wang CJ, Lee CL, Huang HY. Urinary tract injury in laparoscopic-assisted vaginal hysterectomy. J Minim Invasive Gynecol 2007; 14: 600-5.
17. Suprasert P, Euathrongchit J, Suriyachai P, Srisomboon J. Hydronephrosis after radical hysterectomy: a prospective study. Asian Pac J Cancer Prev 2009; 10: 375-8.
18. Tsurusaki T, Hoshino K, Igawa T, Koga S, Matsuya F, Yamashita S, et al. Clinical examination and therapies of hydronephrosis after radical hysterectomy. Nihon Hinyokika Gakkai zasshi 1994; 85: 328-32.
19. Demos TC, Churchill R, Flisak ME, Poor CT, Schuster GA. The radiologic diagnosis of complications following gynecologic surgery: radiography, computed tomography, sonography, and scintigraphy. Crit Rev Diagn Imaging1984; 22: 43-94.
20. Wu K, Zhang WH, Zhang R, Li H, Bai P, Li XG. [Analysis of postoperative complications of radical hysterectomy for 219 cervical cancer patients]. Zhonghua zhong liu za zhi 2006; 28: 316-9.
21. Lukanovic A, Rakar S. Uroloske komplikacije posle radikalne histerektomije [Urologic complications after radical hysterectomy]. Jugosl Ginekol Perinatol1989; 29: 201-2.
22. Paick SH, Oh SJ, Song YS, Kim HH. The natural history of hydronephrosis after radical hysterectomy with no intraoperatively recognisable injury to the ureter: a prospective study. BJU Int 2003; 92: 748-50.
23. Ulmsten U. Obstruction of the upper urinary tract after
treatment of carcinoma of the uterine cervix. Acta obstetricia et gynecologica Scandinavica. 1975;54(4):297-301.
24. Larson DM, Malone JM Jr, Copeland LJ, Gershenson DM, Kline RC, Stringer CA. Ureteral assessment after radical hysterectomy. Obstet Gynecol 1987; 69: 612-6.
25. Kim C, Song YS, Kim HH. The changes and natural progress of hydronephrosis following radical hysterectomy: a prospective study. Korean J Urol 2002; 43: 1003-7.
26. Hazewinkel MH, Gietelink L, van der Velden J, Burger MP, Stoker J, Roovers JP. Renal ultrasound to detect hydronephrosis: a need for routine imaging after radical hysterectomy? Gynecol Oncol 2012; 124: 83-6.
27. Woo HL, Goldenberg SL, Simpson ML, Cooperberg PL. Hydronephrosis after simple hysterectomy for benign disease: a prospective study. Can J Urol 1997; 4: 445-6.
28. Gautier C, Gilliaux P, Vanderick G, De Muylder E. Early detection of ureteral injuries associated with hysterectomy. A prospective echographic study.
J Gynecol Obstet Biol Reprod (Paris) 1987; 16: 69-74.
29. Hildebrandt T, Mueller A, Thiel F, Häberle L, Cupisti S, Beckmann M, et al. Mild hydronephrosis after uncomplicated hysterectomy. Eur J Obstet Gynecol Reprod Biol 2013; 168: 102-6.
30. Patel K, Batura D. An overview of hydronephrosis in adults. Br J Hosp Med (Lond) 2020; 81: 1-8.
31. Mönch R, Chiari R, Kraus A. Comparative studies of renosonography and intravenous pyelography prior to and following hysterectomy. Geburtshilfe Frauenheilkd1983; 43: 97-9.
32. Helin-Martikainen HL, Kirkinen P, Heino A. Ultrasonography of the ureter after surgical trauma. Surg Endosc 1998; 12: 1141-4.
33. Lynch TH, Martínez-Piñeiro L, Plas E, Serafetinides E, Türkeri L, Santucci RA, et al. EAU guidelines on urological trauma. Eur Urol 2005; 47: 1-15.
34. 34. Wijaya T, Lo TS, Jaili SB, Wu PY. The diagnosis and management of ureteric injury after laparoscopy. Gynecology and Minimally Invasive Therapy 2015; 4: 29-32.
35. Whitehouse GH. The radiology of urinary tract abnormalities associated with hysterectomy. Clin Radiol 1977; 28: 201-10
IssueVol 15, No 1 (March 2021) QRcode
SectionOriginal Articles
DOI https://doi.org/10.18502/jfrh.v15i1.6068
Hydronephrosis Hysterectomy Surgery

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Mansour Ghanaie M, Asgari SA, Haghbin A, Mehdizade F, Asgari Ghalebin SM. Post-Hysterectomy Transient Hydronephrosis: A Prospective Study. J Fam Reprod Health. :13-18.