Early, Aggressive Management of Intraoperative Ureteral Injuries

Hoch, William H.; Kursh, Elroy D.; Persky, Lester

doi:10.1016/s0022-5347(17)67075-7

Cited by 36 publications

(8 citation statements)

References 5 publications

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“…hysterectomy) the ureter can be skeletonized when dissecting out adjacent tumour, and so risk ischaemia and delayed necrosis [67,71,77,79,82,92,93,108,113]. Radical hysterectomy may also require en-bloc resection of a segment of ureter [116].…”

Section: Risk Factors/preventionmentioning

confidence: 99%

“…Unfortunately most ( > 65%) iatrogenic ureteric injuries and most (75-93%) blunt PUJ injuries are discovered after a delay [41][42][43][44][45]65,71,74,82,85,92,109,111,117]. Injuries that are detected after surgery or delayed tend to be more complex, require more complex repairs, require multiple procedures, and have higher rates of nephrectomy and death [7,13,15,34,41,45,74,117].…”

Section: Managementmentioning

confidence: 99%

See 1 more Smart Citation

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

Brandes¹,

Coburn²,

et al. 2004

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The Consensus on Genitourinary Trauma continues this month with an evidence‐based analysis, by a team of experts under the chairmanship of Dr Jack McAninch, of current reports on the diagnosis and management of ureteric trauma. This is quite a unique document, and of interest to all urologists; not only as a consensus on how this condition should be managed, but also as a model of how to review current publications.

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Section: Risk Factors/preventionmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

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

Brandes¹,

Coburn²,

et al. 2004

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“…Therefore, an attempt to introduce a JJ stent immediately after making a delayed diagnosis of ureteral injury should be the treatment of choice in most patients and as proven by our material also later than 14 days after an injury. It is not always possible to accomplish this procedure for technical reasons and despite repeated attempts a stent cannot always be introduced above obstruction using an ascending route [15][16][17][18][19][20]. If an attempt to catheter- ize failed or it has not been made, the formation of renal fistula is the next or initial step of management.…”

Section: Discussionmentioning

confidence: 99%

“…These patients should not await reconstructive surgery for several months under the PN cover, but depending on their clinical condition should be operated much sooner if not immediately after making a diagnosis of ureteral injury. Many reports indicate that such treatment is as effective as postponed surgery [15,17,18,[22][23][24][25][26][27]. A prompt reoperation, which couldn't be avoided anyhow in those cases, makes the patient to recover faster.…”

Section: Discussionmentioning

confidence: 99%

Evolution in the approach to overlooked ureteral injuries after gynecological surgery

et al. 2016

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Objectives: To analyzed the therapeutic results for patients with overlooked iatrogenic ureteral injuries after gynecological surgery, treated at the department since 1990. Before the era of endourology, ureteral injuries were operated on immediately after making a diagnosis. This approach was changed after the popularization of percutaneous nephrostomy (PN) and ureteral stenting using a JJ stent. Material and methods:27 patients who were diagnosed with a ureteral injury between the first and sixty-fourth day after injury were included. Only PN was performed in 21 patients (group A). In 6 patients, a JJ stent was introduced either immediately after making a diagnosis or after PN (group B). Results:In group A, a good therapeutic result was obtained in only 6 patients (28.6%). Of the 12 patients subjected to PN up to two weeks after injury, 5 had a good result without a need for repair surgery. Of the 9 patients with an injury diagnosed after 3 weeks, only one had a good therapeutic outcome. In Group B, a good result was achieved in 5 out of 6 patients. In 2 patients, a JJ stent was introduced immediately after making the diagnosis, and, in 3 patients, after PN. A successful attempt to "tunnelize" a complete and long obstruction in the sixth patient failed. Conclusions:Attempting to introduce a JJ stent should be the treatment of choice in patients with an overlooked iatrogenic ureteral injury. If an attempt to introduce the JJ stent fails, PN should be performed as a first step to manage the injury.

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“…Conventional management of ureteric injury presenting in the postoperative period has been by open surgery, particularly when faced with ureterovaginal fistula [13]. With more recent developments in endourological techniques and equipment, the use of ureteric stenting as a primary manoeuvre is amassing an increasing volume of supportive evidence.…”

Section: Discussionmentioning

confidence: 99%

The Management of Bilateral Ureteric Injury following Radical Hysterectomy

Shaw

Tomes

Rix

et al. 2008

Advances in Urology

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Iatrogenic ureteric injury is a well-recognised complication of radical hysterectomy. Bilateral ureteric injuries are rare, but do pose a considerable reconstructive challenge. We searched a prospectively acquired departmental database of ureteric injuries to identify patients with bilateral ureteric injury following radical hysterectomy. Five patients suffered bilateral ureteric injury over a 6-year period. Initial placement of ureteric stents was attempted in all patients. Stents were placed retrogradely into 6 ureters and antegradely into 2 ureters. In 1 patient ureteric stents could not be placed and they underwent primary ureteric reimplantation. In the 4 patients in which stents were placed, 2 were managed with stents alone, 1 required ureteric reimplantation for a persistent ureterovaginal fistula, and 1 developed a recurrent stricture. No patient managed by ureteric stenting suffered deterioration in serum creatinine. We feel that ureteric stenting, when possible, offers a safe primary management of bilateral ureteric injury at radical hysterectomy.

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Early, Aggressive Management of Intraoperative Ureteral Injuries

Cited by 36 publications

References 5 publications

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

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

Evolution in the approach to overlooked ureteral injuries after gynecological surgery

The Management of Bilateral Ureteric Injury following Radical Hysterectomy

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