Iatrogenic Ureteric Injuries: Incidence, Aetiological Factors and the Effect of Early Management on Subsequent Outcome

Al-Awadi, Khaleel A.; Kehinde, Elijah O.; Al-Hunayan, Adel; Al-Khayat, Ahmed

doi:10.1007/s11255-004-7970-4

Cited by 111 publications

(104 citation statements)

References 14 publications

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“…quency of complications varies between 0.5% and 10% in the literature (1)(2)(3). Ureteral avulsion is the most serious complication and occurs in 0-0.5% patients (4).…”

Section: Original Papermentioning

confidence: 99%

The management of total avulsion of the ureter from both ends: Our experience and literature review

Sevinc¹,

Balaban²,

Özkaptan³

et al. 2016

Arch Ital Urol Androl

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Objective: To evaluate the treatment modalities of total ureteral avulsion and to clarify the risk factors of this serious complication. Methods: This study retrospectively analyzed the data of 3 patients with complete ureteral avulsion during ureteroscopy. Of the three patients, two had distal ureteral complete avulsion, and one total ureteral avulsion on both ends. Ureteroneocystostomy (UNC) was immediately performed after distal ureteral avulsion cases. Ileal ureter substition was performed on the same session after the total ureteral avulsion in both ends. Two of the patients were under chronic use of corticosteroid treatment due to diagnosis of idiopathic trombocytopenic purpura and myastenia gravis and all patients had unsuccesful shockwave litotripsy (SWL) treatment history with at least 1 month period before surgery. Results: The patient who had ileal ureter substitution was followed at 3-month intervals by ultrasonography and renal function tests and she was uneventful after a 2 year follow-up period. The patients treated with UNC were followed up at 3 month interval by ultrasonography and renal function tests. They had normal renal function 1 year after the operation Conclusion: Complete ureteral avulsion is a rare but severe complication. Treatment modality can vary and ileal ureter can be applied succesfully in the total ureter avulsion in both ends when bladder capacity is not enough for a Boari flap. Failed SWL and/or corticosteroid treatment history of patients seems to increase the risk of the ureteral avulsion.KEY WORDS: Avulsion; Lithotripsy; Ureterorenoscopy. quency of complications varies between 0.5% and 10% in the literature (1-3). Ureteral avulsion is the most serious complication and occurs in 0-0.5% patients (4). Treating ureteral avulsion is a challenge. Patient comorbidities, the condition of the kidney, severity of the ureteral damage, and experience of the surgeon can affect the choice of treatment. In this study, we aimed to discuss our experience and possible leading factors of this serious complication in the light of the current literature. MATERIALS AND METHODSWe retrospectively analyzed three ureteral avulsion cases and treatment modalities at two referral hospitals between January 2008 and October 2014. All patients underwent rigid ureteroscopic procedures for removing ureteral stones, and ureteral avulsion occurred during the retrograde examination of the ureter. Of the three patients (1 man, 2 women; age: 28-65 years, one right, two left), the avulsed ureter was repaired during the same session of the ureterorenoscopic surgery. The ureter stones were located in the distal ureter in two patients and in the proximal ureter in one patient. All patients had unsuccessful SWL treatment and at least a 2 week interval before further investigation and treatment were applied. Two patients who have been diagnosed with idiopathic thrombocytopenic purpura and myastenia gravis received chronic corticosteroid treatment. The patients were evaluated with abdominal X-ray, ultrasonography, int...

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“…quency of complications varies between 0.5% and 10% in the literature (1)(2)(3). Ureteral avulsion is the most serious complication and occurs in 0-0.5% patients (4).…”

Section: Original Papermentioning

confidence: 99%

The management of total avulsion of the ureter from both ends: Our experience and literature review

Sevinc¹,

Balaban²,

Özkaptan³

et al. 2016

Arch Ital Urol Androl

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“…25,29,33,34 Overall success rates range from 48% to 88% for balloon dilation, 55% to 85% for endoureterotomy, and 91% to 97% for conventional open surgery. 35 In our series of 10 patients, laparoscopic management of early (6) and late (4) detected ureteral injuries was accomplished in all cases but one (success rate, 90%) despite the fact that it was a uretero-uretero anastomosis, ureterolysis, or ureteral reimplantation.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Management of Iatrogenic Lesions

Abreu

Tanaka²,

Abreu³

et al. 2008

Journal of Endourology

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Purpose: To present our series of patients who underwent laparoscopic correction of iatrogenic lesions and a review of the literature. Patients and Methods:We evaluated 23 patients who underwent laparoscopic correction of iatrogenic lesions.Thirteen patients had open surgery, 6 had an endoscopic procedure, and 4 had a laparoscopic approach as the first surgical procedure. Vesicovaginal fistulas (VVF) developed in seven patients after open abdominal hysterectomies, and 1 patient presented with a VVF after ureterolithotripsy. A urethral cutaneous fistula developed in one patient after a laparoscopic resection of endometriosis nodules, and 1 patient presented with a ureterovaginal fistula after a perineoplasty. Three patients presented with encrusted ureteral stents after ureterolithotripsy. Ureteral stenosis developed in seven patients: three after open abdominal surgery, three after ureteroscopy, and one after pyeloplasty. One patient had a ureteral injury during laparoscopic partial nephrectomy, and two patients had bowel injuries after a tension-free vaginal tape procedure and a laparoscopic radical prostatectomy. Results: All patients underwent laparoscopic correction of the iatrogenic injuries. One patient had an early recurrence of a VVF, and one patient had a recurrence of a ureteral stenosis. There was one conversion to open surgery because of technical difficulties and one major bleeding event that necessitated blood transfusion. A lower limb compartmental syndrome developed in one patient. Conclusion: Despite the small number of patients and different types of surgeries performed, laparoscopic management of iatrogenic lesions seems to be feasible and safe in experienced hands. Its precise role in the management of this stressful condition still needs to be determined. 1279

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“…Al-Awadi et al 5) found that the length of hospitalization, incidence of urinary leak, adhesions, and sepsis were significantly higher in the delayed diagnosis group.…”

Section: Intraoperative Ureteral Injury Identificationmentioning

confidence: 98%

“…Although may occur at any segment of the ureter, it most often occurs distally near the takeoff of the IMA or at the pelvic brim. Al-Awadi et al 5) reported 82 cases of IUI over a period of 4 years. Anatomical locations were 65%, 20%, and 15% for distal, mid, and proximal ureteral injury, respectively.…”

Section: Prevention Of Iatrogenic Ureteral Injury In Colorectal Surgerymentioning

confidence: 99%

See 1 more Smart Citation

Ureteral Injury During Colorectal Surgery: Two Case Reports and a Literature Review

Yellinek

Krizzuk

Nogueras

et al. 2018

J Anus Rectum Colon

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Abstract:Iatrogenic ureteral injury (IUI) is a dreaded complication of abdominopelvic surgery. Although rare, it is associated with severe consequences. This complication most commonly occurs during gynecological procedures but may also occur during colorectal surgeries. We present two cases of IUI in patients in whom the ureteric stents were electively placed. The first case was a 71-year-old male with no significant medical history. The patient underwent an elective laparoscopic sigmoidectomy for complicated diverticulitis. During the procedure, a proximal IUI occurred, and was recognized and repaired. The second case occurred in a 68-year-old male with a history of multiple complicated abdominal surgeries. The patient underwent a second redo low anterior resection for a long preanastomotic stricture. The IUI occurred in the right fibrosed presacral plane, approximately 3 cm proximal to the bladder. The ureter was reimplanted to the bladder during the same procedure. We will also present a literature review of IUI, including the risk factors, intraoperative prevention, and repair options.

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Iatrogenic Ureteric Injuries: Incidence, Aetiological Factors and the Effect of Early Management on Subsequent Outcome

Cited by 111 publications

References 14 publications

The management of total avulsion of the ureter from both ends: Our experience and literature review

The management of total avulsion of the ureter from both ends: Our experience and literature review

Laparoscopic Management of Iatrogenic Lesions

Ureteral Injury During Colorectal Surgery: Two Case Reports and a Literature Review

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