Percutaneous Minimally Invasive Management of Iatrogenic Ureteral Injuries

Koukouras, D.; Petsas, Theodore; Liatsikos, Evangelos; Kallidonis, Panagiotis; Sdralis, Elias; Adonakis, Georgios; Panagopoulos, C.; Al-Aown, Abhulrahman; Decavalas, George; Perimenis, Petros; Siablis, Dimitrios; Karnabatidis, Dimitrios

doi:10.1089/end.2010.0153

Cited by 61 publications

(38 citation statements)

References 21 publications

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“…75-81 Immediate repair can be considered in certain clinical situations if the injury is recognized within one week (e.g., injury located near a surgically closed viscus, such as bowel or vagina, or if the patient is being re-explored for other reasons).…”

Section: Guideline Statementsmentioning

confidence: 99%

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Urotrauma: AUA Guideline

et al. 2014

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Purpose The authors of this guideline reviewed the urologic trauma literature to guide clinicians in the appropriate methods of evaluation and management of genitourinary injuries. Methods A systematic review of the literature using the MEDLINE® and EMBASE databases (search dates 1/1/90-9/19/12) was conducted to identify peer-reviewed publications relevant to urotrauma. The review yielded an evidence base of 372 studies after application of inclusion/exclusion criteria. These publications were used to inform the statements presented in the guideline as Standards, Recommendations or Options. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate) or C (low). In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions.

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Section: Guideline Statementsmentioning

confidence: 99%

“…If nephrostomy alone does not adequately control the urine leak, options then include placement of a periureteral drain or immediate open ureteral repair. 75-83 …”

Section: Guideline Statementsmentioning

confidence: 99%

Urotrauma: AUA Guideline

et al. 2014

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“…According to the literature, more than 50% of all iatrogenic injuries occur during gynecologic surgery [3]. Many studies assessing the incidence of ureteral injuries in gynecologic procedures detail ureteral injury rates ranging from 0.1 to 2.5% [4-7]. …”

Section: Introductionmentioning

confidence: 99%

Ureteral Injury in Gynecologic Surgery: A 5-Year Review in A Community Hospital

Park¹,

Park²,

Song³

et al. 2012

Korean J Urol

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PurposeWe reviewed the cases of ureteral injury during gynecologic surgeries in a community hospital and attempted to find possible options for alleviating these distressing situations.Materials and MethodsA total of 2,927 patients underwent gynecologic surgeries in the last 5 years at our hospital. We retrospectively analyzed the cases, particularly the possible risk factors and management according to the time of detection of the injury. Thirty-five cases (1.2%) were identified with ureteral injury in a total of 2,927 gynecologic surgeries. Risk factors included endometriosis, pelvic inflammatory disease, previous pelvic surgery, history of pelvic radiation, and congenital anomalies. Among 2,927 patients, 522 had predisposing factors for ureteral injuries.ResultsThe incidence of ureteral injury in laparoscopic cases was 1.1%, similar to the cases of laparotomy (1.2%). The rate of ureteral injury was significantly higher in the group with risk factors (2.7%) than in the group without risk factors (0.9%; p=0.002). Prophylactic ureteral stenting was performed in 101 of 522 patients with risk factors according to the gynecologic surgeon's preference. The injury rate (1.0%) in the stenting group was lower than that in the non-stenting group (3.1%; p=0.324). Management of ureteral injuries was successful in all cases. Of the patients with postoperatively diagnosed injuries, two patients were managed with secondary procedures, such as retrograde balloon dilatation or ureteroneocystostomy.ConclusionsThe incidence of ureteral injury was significantly higher in cases having risk factors than in cases without risk factors. Surgeons should be cautious to avoid ureteral injury during gynecologic surgery, especially in patients with risk factors.

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“…Ureteral strictures that are diagnosed early and are relatively short (less than 2 cm) can be managed by stenting and other endourologic procedures such as anterograde dilation and incision. 45 Surgical excision and repair is generally required when endoscopic measures fail, the stricture is discovered late, or there is a large segment of ureter involved. Postoperative repair follows the same principles and techniques as described in the section on "Intraoperative Treatment of Ureteral Injuries."…”

Section: Ureteral Injuriesmentioning

confidence: 99%

Prevention, Recognition, and Management of Urologic Injuries During Gynecologic Surgery

Sharp

Adelman

2016

Obstetrics &Amp; Gynecology

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The urethra, bladder, and ureters are particularly susceptible to injury during gynecologic surgery. When preventive measures fail, prompt recognition and management of injury can avoid long-term sequelae such as fistula formation and loss of renal function. Intraoperative identification should be the primary goal when an injury occurs, although this is not always possible. Postoperative injury recognition requires a high level of suspicion and vigilance. In addition to history and physical examination, appropriate radiologic studies can be useful in localizing injury and planning management strategies. Some injuries may require Foley catheter drainage or ureteral stenting alone, whereas others will require operative intervention with ureteral resection and reanastomosis or reimplantation. Prompt restoration of urinary drainage or diversion will avoid further renal compromise.

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Percutaneous Minimally Invasive Management of Iatrogenic Ureteral Injuries

Abstract: The minimally invasive management of ureteral injuries is a safe and efficient method for both ureteral obstruction and/or laceration in a wide range of iatrogenic ureteral injuries.

Cited by 61 publications

References 21 publications

Urotrauma: AUA Guideline

Urotrauma: AUA Guideline

Ureteral Injury in Gynecologic Surgery: A 5-Year Review in A Community Hospital

Prevention, Recognition, and Management of Urologic Injuries During Gynecologic Surgery

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