Management of iatrogenic ureteral injury

Abstract

Iatrogenic injury to the ureter is a potentially devastating complication of modern surgery. The ureters are most often injured in gynecologic, colorectal, and vascular pelvic surgery. There is also potential for considerable ureteral injury during endoscopic procedures for ureteric pathology such as tumor or lithiasis. While maneuvers such as perioperative stenting have been touted as a means to avoid ureteral injury, these techniques have not been adopted universally, and the available literature does not make a case for their routine use. Distal ureteral injuries are best managed with ureteroneocystostomy with or without a vesico-psoas hitch. Mid-ureteral and proximal ureteral injuries can potentially be managed with ureteroureterostomy. If the distal segment is unsuitable for anastomosis then a number of techniques are available for repair including a Boari tubularized bladder flap, transureteroureterostomy, or renal autotransplantation. In rare cases renal autotransplantation or ureteral substitution with gastrointestinal segments may be warranted to re-establish urinary tract continuity. Laparoscopic and minimally invasive techniques have been employed to remedy iatrogenic ureteral injuries.

Iatrogenic ureteric injuries in open abdominopelvic surgery: a five year experience in Maiduguri, North Eastern Nigeria

“…[8][9][10] The current study found distal ureter was the commonest site affected, suture ligation is the commonest injury and unilateral injuries were commoner, similar to study by Chalya et al in Tanzania.…”

Injury to Urinary Organs during Natural Deliveries, Caesarean Sections and Peripartum Hysterectomies

“…during caesarean section, the left lateral wall of the bladder as well as the left ureter are found closer to the midline [22]. More frequent occurrences of left ureteral lesions have been reported in the studies of this complication following gynecological and obstetric operations, mainly after hysterectomy with adnexa [17]. Complication of that type was also noted in the presented material.…”

“…The repair operation consists in removing the ligature/ureteral clip. In case of doubt as to the blood supply on the ligated site, the ischemic fragment of the ureter should be resected and reconstructed in a manner dependent on the location of the injury [12,17]. Table 4: Provision of blood preparations in women with injuries to the urinary organs after deliveries and surgical operations.…”

An Alternative Technique for Treating Complex Ureteral Strictures and Defects using A Peritoneal Graft

“…The ureteric strictures can be caused by several factors like stones, infections, fibrosis, malignancy, radiotherapy or in most cases by iatrogenic surgical trauma occurred during gynecological, colorectal and vascular surgery or after endourological surgery [10][11][12]. The strictures, that are too long or not suitable for treatment with end to end anastomosis, Boari flap or Psoas hitch technique, may require an ileal ureter, autotransplantation or nephrectomy.…”