Management of Complete Ureteral Avulsion and Literature Review: A Report on Four Cases

Ge, Chengguo; Li, Qiansheng; Wang, Luofu; Jin, Fang; Li, Yanfeng; Wan, Jianxin; Lan, Weihua; Liang, Peihei

doi:10.1089/end.2010.0303

Cited by 28 publications

(30 citation statements)

References 15 publications

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“…Among all complications of ureteroscopic lithotripsy procedure, complete avulsion of the proximal ureter is one of the most challenging that happens in 0.06–0.45% of the cases [12]. …”

Section: Discussionmentioning

confidence: 99%

Immediate successful renal autotransplantation after proximal ureteral avulsion fallowing ureteroscopy: a case report

Alizadeh

Valizadeh

Rahimi

2017

Journal of Surgical Case Reports

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The patient was a 51-year-old lady with left flank colicky pain accompanied with nausea and vomiting for a month. Transurethral lithotripsy and ureteral stent placement was considered for the patient. The patient had a narrow ureteral lumen and while bringing the ureteroscope out, ureteral avulsion occurred at a distance approximately 4 cm from ureteropelvic junction. After bringing the uretroscope out, the avulsed ureter was observed hanging at the tip of the ureteroscope. Anastomosis of the ureter to the bladder was accomplished with Lich–Gregoir technique. A drainage tube was inserted at the site of incision and the surgical wound closed. The patient was discharged with acceptable general condition after 3 days and the drainage tube removed. The ureteral stent was removed 4 weeks later by cystoscopy. An ultrasound imaging study of the genitourinary system 8 months into the patients follow up showed normal size, echo and cortical thickness in the operated kidney after renal autotransplantation.

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“…Among all complications of ureteroscopic lithotripsy procedure, complete avulsion of the proximal ureter is one of the most challenging that happens in 0.06–0.45% of the cases [12]. …”

Section: Discussionmentioning

confidence: 99%

Immediate successful renal autotransplantation after proximal ureteral avulsion fallowing ureteroscopy: a case report

Alizadeh

Valizadeh

Rahimi

2017

Journal of Surgical Case Reports

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“…Among these complications, ureteral avulsion is the most severe and challenging condition to manage and occurs in 0.06e0.45% of cases. 1 One of the most frequently reported causes of complete ureter avulsion was stone manipulation with a basket. 2 However, the immediate cause of ureter avulsion in the above cases was narrowing of the ureteral lumen.…”

Section: Discussionmentioning

confidence: 99%

Management of complete ureteral avulsion in ureteroscopy

et al. 2014

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a b s t r a c tUreteral avulsion is an uncommon yet severe complication of ureteroscopy. Among 8336 patients who received ureteroscopic procedures in our hospital from December 2001 to December 2011, we encountered two cases of ureteral avulsion. The first of these experienced disruption at the ureteropelvic junction due to extraction of the tubular ureter from the urethra, which was corrected by immediate open surgery to reposition and anastomose the ureter. The second patient sustained a proximal ureteral disruption following retrieval of the ureteroscope, which was wedged in the narrow lumen of the proximal ureter, and led to simultaneous extraction of the distal ureter. Immediate surgical intervention was performed to maintain ureteral continuity. Mild hydronephrosis was observed in kidneys that were ipsilateral to the ureteral avulsion in both patients. However, no physical discomfort or loss of renal function was indicated after 12 months.

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“…14 Other possible techniques used for ureteral reconstruction include psoas hitch, Boari flap, or a combination of both, ileal interposition, transureteroureterostomy, permanent nephrostomy, appendix or colon interposition, renal descensus, ureterocalicostomy, and pyeloureterostomy plus greater omentum investment outside the avulsed ureter, if these modalities are not possible than as a last resort nephrectomy may have to be performed. 4,6,[14][15][16][17][18] due to the use of small caliber endoscopes the long term complication of uretreic stricture is not frequently observed and can be expected in less than 1% of the patients. 19 However in our study no case of post operative/iatrogenic stricture was identified with a minimum follow up period of one year.…”

Section: Figure-1 Increase In Number Of Cases Managed By Ureterorenomentioning

confidence: 99%

Ureterorenoscopy, a review of first three years of experience for ureteric stone disease.

Awan

Bhatti

Awan

2019

TPMJ

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Objectives: Ureterorenoscopy is a diagnostic and therapeutic modality, used for different ureteral and renal pathologies. It has virtually replaced open surgery for ureteric calculi. Study Design: Observational. Setting: Urology Department of Sargodha Medical College, Sargodha. Period: 2011-2015. Material and Methods: All cases who underwent URS for stone disease during the study period were included in the study. The initial criterion was a bit strict, due to minimum experience, which limited only clinically fit patients with no co-morbid illnesses, with stone size of 1 cm or less, located in middle or preferable in distal ureter, single stone was also preferred, but later the criterion was relaxed with gain confidence. The procedures were performed under general anesthesia using R Wolf Ureterorenoscope. Results: The total number of cases included in the study were 332 of which 189 were males and 143 were females. Average age being 42.82 years. The total number of stones managed were 354 (in 22 cases the stones were bilateral). The average size of stones was 1.2 cm. DJ stent was used in 78 cases. Complications were observed in 14.76 percent cases (2.71% major and 12.05% minor). No deaths occurred in the study group. Conclusion: Uretero renoscopy is an excellent tool for the management of ureteral stone disease so much so that these cases, after sufficient experience, can be managed as day cases. The complication rate can be controlled by careful patient selection. Being intuitive and stopping the procedure on the very first hint of something going wrong like the scope being stuck or requiring excessive force. Strictures should not be traversed without adequate prior dilatation. The operator should have sufficient experience with open surgery.

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Management of Complete Ureteral Avulsion and Literature Review: A Report on Four Cases

Abstract: Complete ureteral avulsion is a rare but severe complication. Autotransplantation of kidney and ureterovesical anastomosis may result in positive outcomes in patients with proximal ureteral avulsion.

Cited by 28 publications

References 15 publications

Immediate successful renal autotransplantation after proximal ureteral avulsion fallowing ureteroscopy: a case report

Immediate successful renal autotransplantation after proximal ureteral avulsion fallowing ureteroscopy: a case report

Management of complete ureteral avulsion in ureteroscopy

Ureterorenoscopy, a review of first three years of experience for ureteric stone disease.

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