Interventional radiology in iatrogenic ureteral leaks: case series and literature review

Abstract

Iatrogenic ureteral injuries are a dramatic complication in medical practice. Nowadays there are no universal guidelines for their management. The aim of our study was to evaluate the feasibility of the percutaneous treatment in restoring ureteral integrity in 19 patients that came to our attention. In each case retrograde stenting failed and patients were candidates for re-surgery. Our strategy consists of two phases. The first step is the nephrostomy that allows an external urinary diversion putting dry the damaged ureteral segment. The second step is the anterograde ureteral double-J stenting that keeps near the two stumps promoting the healing of the injured tract. In complete sections, when both retrograde and anterograde stenting singularly failed, we performed a rendez-vous technique with a combined radiological trans-nephrostomic access and urological cystoscopic approach to realign and catheterize the ureteral stumps. In patients with Bricker urinary diversion, peri-anastomotic leaks were treated by positioning a multi-hole pig-tail catheter with the inner end in the renal pelvis and the distal portion outgoing from the cutaneous stoma. Subsequent pyelographic controls demonstrated the resolution of the ureteral leak in all patients and none required a surgical re-intervention. Nephrostomies were removed and ureteral stents were regularly changed. We conclude that interventional uro-radiology may offer a valid conservative option in iatrogenic urinary injuries.

External-internal ureteral catheterization technique in treatment of ureteral injuries

“…In the literature, it has been reported that the most affected segment in ureteral injuries is the distal third of the ureter, at a rate of 51%, followed by the proximal and middle thirds of the ureter at rates of 30% and 19%, respectively [3,11]. In our study, the most commonly affected segment was the distal third of the ureter at a rate of 79%.…”

Diagnostic and Interventional Radiology Management of Ureteral Iatrogenic Leakage after Gynecologic Surgery

“…In our study, the aim of restoring the integrity of the ureter was achieved in 12/15 patients (80%), consistent with data reported in the medical literature (64.7%–100%) [ 1 , 16 , 28 ]. Balloon dilatation was required in 4/15 patients due to iatrogenic strictures, always successfully.…”

“…Postoperative diagnosis of ureteral lesions can be very challenging because clinical manifestations are often non-specific [ 1 ].…”

“…Although extremely rare, iatrogenic ureteral injuries are a severe complication of gynecological surgery [ 1 ]. The risk of damage increases when the normal anatomy is altered by primary pathologic factors, by pelvic adhesions, or when the ureter is poorly recognizable because of intraoperative complications, such as severe bleeding [ 2 ].…”

Possibilities of Interventional Technologies in Treatming of Iatrogenic Ureteral Injuries in Oncological Patients

“…В своей работе мы используем мочеточниковые стенты диаметром 6F, что позволяет поддерживать естественный пассаж мочи. В исследовании Trombatore С et al мочеточниковые стенты были удалены у четырех пациентов после среднесрочного периода наблюдения 5,5 мес [23]. В нашей работе в одном случае пациенту мочеточниковый стент удален через 3 мес без признаков нарушения естественного пассажа мочи в отдаленном периоде.…”