Ureter Complications: A Rare Complication but which Requires the Highest Degree of Management Expertise

Abstract

Introduction: 0% of all urinary tract injuries are iatrogenic lesions. Although they only occur in < 5%, they can lead to severe ipsilateral renal dysfunctions. These lesions can be treated with extensive knowledge on the genesis of the lesion, the anatomy, the individual patient’s history and high operative expertise in diverse surgical methods. Material and Methods: In this article, we show which reconstruction options are possible, depending on the lesion’s severity according to the AAST and EAU Guidelines from 2009 on the classification of ureter injuries, as well as the localisation. A special focus is on the anatomy. It is important to adhere to surgical ground principles, such as making sure all pathological tissue is removed, the ureter ends are spatulated and a tension-free and watertight anastomosis is maintained. Results: Iatrogenic ureter lesions are rare complications, but being able to deal with these frequently requires a urologist’s expertise. Whenever surgeons operate close to the ureters, there is always a risk of an iatrogenic ureter lesion, which in turn requires that all available reconstructive measures are used dynamically. Conclusion: Ureter complications are rare but require surgeons’ excellent management expertise.

Ureteral Injuries in Coloretal Surgery - Bibliographic Review

“…For the diagnosis of lesions, it has been reported from a careful visual inspection in the intraoperative period to the use of retrograde or anterograde ureteropyelography in the suspected postoperative ureteral lesion (AL-AWADI et al, 2005;ANDERSEN et al, 2015;ESPARAZ et al, 2015). Computed tomography with intravenous contrast was the most used exam in late diagnosis, with high sensitivity (AL-AWADI et al, 2005;EPARAZ et al, 2015;FERRARA & KANN, 2019;WEIGAND et al, 2018). Minimal ureteral lesions can heal without clinical manifestations or sequelae; however, significant injuries, if not identified and corrected early and properly, lead to relevant signs and symptoms (ELLIOTT & MCANINCH, 2006).…”

“…Distal ureter injuries were treated with ureteroneocystostomy in most cases (BERALDO et al, 2013;SPEICHER et al, 2014). If the distal segment of the ureter was not suitable for anastomosis, other techniques were employed, such as the Boari technique and transureteroureterostomy (AMBANI et al, 2020;ESPARAZ et al, 2015;FERRARA & KANN, 2019;WEIGAND et al, 2018). In very few situations, when extensive injury to the entire ureter occurred, interposition of a gastrointestinal organ segment, renal autotransplantation or nephrectomy was necessary (ESPARAZ et al, 2015;WEIGAND et al, 2018).…”

“…If the distal segment of the ureter was not suitable for anastomosis, other techniques were employed, such as the Boari technique and transureteroureterostomy (AMBANI et al, 2020;ESPARAZ et al, 2015;FERRARA & KANN, 2019;WEIGAND et al, 2018). In very few situations, when extensive injury to the entire ureter occurred, interposition of a gastrointestinal organ segment, renal autotransplantation or nephrectomy was necessary (ESPARAZ et al, 2015;WEIGAND et al, 2018). In left-sided ureteral lesions, the presence of colorectal cancer with previous radiotherapy and chemotherapy treatments increased the incidence of future complications after correction and the need for secondary intervention (ESWARA et al, 2015).…”

“…In cases where the injury occurred in an area with a previously placed ureteral catheter, delayed treatment using minimally invasive laparoscopic and robotic percutaneous techniques aided by interventional radiology has been reported (ESPARAZ et al, 2015;WEIGAND et al, 2018). ).…”

Outcomes and treatment failure after open or robotic ureteral reconstruction for iatrogenic injuries

“…2,9,16,17 Whereas several series confirmed the efficacy of ureterocystoneostomy with or without bladder psoas hitch in the management of pelvic ureteral iatrogenic injuries, only few studies analysed the outcomes of reconstructive surgery for mid-or upper-ureter lesions. 3,[8][9][10]18 Moreover, no study has ever compared perioperative outcomes and failure rate of open versus robotic ureteral reconstruction for iatrogenic injuries.…”