Management of iatrogenic ureteric injury with retrograde ureteric stenting: an analysis of factors affecting technical success and long-term outcome

Abstract

Background Iatrogenic ureteral injuries arise as serious complication following obstetrics, gynecological, general, and urological surgery with incidence in the range of 0.5-10%. Retrograde placement of double-J ureteric stent is a possible treatment option if the injury is not recognized at the time of surgery. Purpose To assess technical success and long-term outcome associated with retrograde ureteric stent insertion for iatrogenic ureteric injury. Material and Methods Between 1999 and 2011, 26 patients with initially unrecognized iatrogenic ureteric injury underwent initial management with retrograde ureteric stenting. Full case-notes were available for review in 25 patients. Results The mean interval from injury to attempted stenting was 19.4 days. Successful retrograde ureteric stenting was achieved in 21/25 patients (81%). Retrograde stenting failed in four patients, and nephrostomy followed by alternative procedures were performed instead. At a median follow-up interval of 9.7 months, normal anatomy was demonstrated on 12/21 patients (57%) and a stricture was observed in 6/21 patients (28%) with three requiring surgical intervention. Conclusion Retrograde stenting is a safe and efficient initial management in patients with iatrogenic ureteric injuries.

Cystoscopy at the time of benign hysterectomy: a decision analysis

“…In the event of a true ureteral injury, abnormal retrograde pyelogram could lead to attempt at retrograde stent placement or reimplantation of the ureter. 5 Unsuccessful management with stenting would require ureteral reimplantation.…”

Does Endourological Intervention a Suitable Treatment Options in Management of Iatrogenic Thermal Ureteral Injury?

“…However, endourological approaches are often chosen as initial care due to short hospital stay, fewer complication, and low treatment cost (26). Reported success rates for endoscopic IUI management range from 17% to 84% (13)(14)(15)(16)(17)(18). In study, we initially treated 59.25% (n = 16/27) of the patients with endourological methods.…”

“…Ureteroureterostomy or ureteral reimplantation is recommended for the middle and distal ureteral injury (10,11). However, some studies suggest endourological intervention for first-line treatment in the IUI (12)(13)(14)(15). The success rates have been documented across such a broad spectrum due to the heterogeneity of IUI etiology, the low density of cases, and the diversity of treatment options (17-84%) (13)(14)(15)(16)(17)(18).…”

Morbidity and predictors of delayed recognition of iatrogenic ureteric injuries

“…Surgical techniques to repair IUI include uretero-neocystotomy, ureteroureterostomy, suture repair, ureteric stent placement and nephrostomy tube placement (1,(5)(6)(7). Various case series (maximum 164 patients) have evaluated the outcomes of IUI repair and found very high success rates if recognized at the time of injury regardless of technique (8)(9)(10)(11)(12)(13)(14).…”