Iatrogenic Ureteral Injury

Abstract

We treated 27 patients with iatrogenic ureteral injuries during a 6-year period. Gynecological operations were the most common antecedent surgical procedures (52 per cent). The diagnosis of ureteral injury was made immediately in 4 patients and was delayed 1 to 34 days in 23. Three of the 4 injuries recognized during an operation were repaired successfully at the time of injury; the primary repair in the remaining patient leaked and ultimately resulted in a nephrectomy. In the delayed diagnosis group retrograde ureteral catheterization was successful in only 1 of 20 attempts. Of the 23 patients with injuries recognized in the postoperative period 11 were managed successfully with percutaneous nephrostomy (with or without stenting) alone, 3 required surgical repair after temporary percutaneous nephrostomy drainage, 4 were treated surgically without prior nephrostomy drainage and 1 had spontaneous resolution of hydronephrosis. The remaining 3 patients required nephrectomy: 1 because of a urinary fistula in a previously irradiated field, 1 because of a concomitant (ipsilateral) renal cell carcinoma and 1 because of renal hypertension. Percutaneous nephrostomy or ureteral stenting was successful as primary therapy in 73 per cent of the patients in whom it was used.

Diagnosis and management of ureteric injury: an evidence‐based analysis

“…Ureteric injuries during vaginal surgery are typically ligations and not detected until after the operation [72,74,81,98,107]. Most injuries were associated with attempts to achieve haemostasis without properly identifying the ureter [98].…”

“…Placing a PCN is usually safer and more universally applicable. Retrograde ureteric stenting is typically unsuccessful (50-95%) and should be attempted only for certain low-grade injuries [13,15,46,49,69,72,100] Antegrade stenting is often successful, particularly after a few days of proximal urinary diversion [49]. If a stent can be placed an open repair is required only for persistent urinary leak or ureteric stricture formation [69,72].…”

Assessing ureteral patency using 10% dextrose cystoscopy fluid: evaluation of urinary tract infection rates

“…Intraoperative recognition of lower urinary tract (LUT) injury is paramount to avoid delayed diagnosis, leading to significant complications such as ureterovaginal fistula or upper tract dysfunction requiring intervention and in some cases, nephrectomy. 3 Most intraoperative ureteral injuries go undetected and are usually diagnosed postoperatively 2,4,5 ; therefore, it is recommended that routine intraoperative cystoscopy be performed during all major gynecological 6,7 and urogynecological surgeries. [8][9][10][11] Intravenous indigo carmine (indigotindisulfonate sodium) is a marker dye produced by Akorn (Lake Forest, IL) and American Regent (Shirley, NY) and has been used routinely by many providers to confirm ureteral patency.…”

Hand-assisted laparoscopic ureteroureterostomy with renal mobilization for delayed recognition of a proximal ureteral injury after lumbar disk surgery

“…10 Low-grade injuries can be sufficiently treated with ureteral stent placement, while the treatment of high- grade injuries depends on the localization and extent of the damage. [10][11][12] Attempts at retrograde and antegrade stent placement were not successful in our patient, which is not entirely unexpected given reported failure rates of 50% to 80% in patients with high-grade ureteral injuries. [13][14][15] Ureteral injuries are classified as immediate if they are recognized within 24 hours, and classified as delayed if the injuries are recognized after 24 hours.…”