Ultrasonography of the ureter during laparoscopic, abdominal and radical hysterectomy.

Abstract

To examine, by perioperative ultrasonography, ureteral anatomy and function during laparoscopic, abdominal and radical hysterectomy. The study group consisted of 36 patients scheduled for laparoscopic, abdominal or radical hysterectomy; there were 12 patients in each group. The ureteral rest-phase diameter, maximal diameter during peristaltic waves and frequency of peristaltic waves were recorded immediately before and after hysterectomy under standard anesthetic conditions with the use of a 7.5-MHz linear laparoscopic ultrasound probe. Ureteral peristaltic activity was decreased and the rest-phase diameter was increased after hysterectomy. The findings were most evident after radical hysterectomy with pelvic lymphadenectomy. Retrograde (cranial) flow was recorded in a majority of the patients. The individual variation was great, particularly after radical surgery. Short- and long-term clinical outcome was normal in all cases. Uncomplicated hysterectomy is followed by changes in ureteral function. Although these changes apparently have no clinical significance, they must be recognized if laparoscopic ultrasonography is applied as a perioperative method to diagnose or exclude surgical ureteral lesions.