Ureteric injuries during cancer surgery presentation and management over a 20-year

Abstract

Background: Iatrogenic ureteral injury rare 0.3-1.5%. complication of abdominopelvic cancer surgery. We aimed to study the risk and management of ureteral injury among cancer patients. Methods: Diagnosis can be achieved retrograde pyelography, ureteroscopy, CT, or intravenous urography. Results: Years 2000 to 2020, 2904 patients in the Department of Surgical oncology, Assuit University, and 47 ureteral injury cases were identified. (1.62), 4/231 cervical cancer, 9/611 ovarian cancer and 7/462 endometrial cancer.,11/818 colon cancer,12/620 rectal cancer, 1/11 prostatic cancer, 3/151 retroperitoneal sarcoma. 34% (radical abdominal hysterectomy 8.5% Wertheim hysterectomies 4%), colorectal surgery colectomy 25.5%, low anterior resection2.1% in radical prostatectomy and 6.4% in retroperitoneal tumor, intraoperative diagnosis 48.9%, 8.5% in laparoscopic surgeries, the distal third (53.2%),23.4% catheterization, complete transection 31.9%; partial 14.9%, ligation 8.5%, laceration in 19.1%, resection. 8.5%; and devascularization in 17%. Fever in 14.9%, abdominal or flank pain in 38.5%. Oligura in 6.4%, ileus in 19.3%, urinary leakage (vaginally or via abdominal wound) in 10.6% rise creatinine in 10.6%, hydronephrosis in 6.4%, urinoma in 27.7%, extravasation in 8.5% asymptomatic in 4.3%, 40.4% percutaneous nephrostomy. 19.1%primary repair Ureteroneocystostomy in (17%) Boari flap in 12.7%, Psoas hitch in 23.4% stenting in 14.9%, 8.5% ileum interposition, anastomosis to contralateral ureter in 4.3%, ureteral stricture 6.4%, ureterovaginal fistulas in 10.6%, acute renal failure 2.1%, peritonitis 4.3, urinary tract infection in 14.9%.Conclusions: The recognition and immediate repair of ureteral injuries early during the same procedure was highly desirable and to avoid a second operation.

A Review on the Etiology, Prevention, and Management of Ureteral Injuries During Obstetric and Gynecologic Surgeries

“…If the transection involves greater than 50% or almost the entire width of the ureter, and the defect between the ends of the ureter is of a length where a tension-free anastomosis is possible, the surgical option involves direct ureter to ureter anastomosis (primary uretero-ureterostomy). 1 , 14 , 16 This approach is also useful in ureteral contusion as a result of clamping by forceps. In this regard, the clamped segment is resected, and a primary uretero-ureterostomy is done ensuring a tension-free anastomosis.…”

“…Ureteroneocystostomy is used to repair injured distal ureter that occurs so close to the bladder that the bladder does not need to be brought up to the ureteral stump with a psoas hitch or Boari procedure. 1 , 14 , 16 Ureteroneocystostomy involves the creation of a submucosal tunnel for a non-refluxing ureteral repair or a refluxing non-tunneled anastomosis that can be considered if the ureteral length is insufficient for tunneling. The distal portion is ligated using permanent or delayed absorbable suture, making it into a blind-ended tube.…”

“…In cases of intraoperative missed diagnosis and delayed recognition, some urologists suggest stent placement as the first line of therapy for ureteral injuries with delayed recognition, 1 while others recommend that these injuries be repaired openly as soon as possible. 14 , 16 , 28 These authors cite low complication rates, which can be as low as in the repair of injuries that are recognized immediately. 1 , 28 However, delayed diagnosis of the ureteral injury itself increases the complication rate of the repair significantly from 10% to 40% in one series, 42 , 43 and some have advocated late repair up to 6 weeks to allow maximal resolution of perioperative inflammation.…”

“…The possible causes of iatrogenic ureteric injuries include gynecologic procedures like abdominal hysterectomy, vaginal hysterectomy, anterior colporrhaphy, laparoscopic hysterectomy; 8 obstetric causes and predisposing factors like cesarean hysterectomy, fetal macrosomia, cephalopelvic disproportion, placenta previa, and morbidly adherent placentas involving the pelvic sidewalls, difficult neonatal 896 extraction, prolonged labor, and abnormal fetal lie. 9,10 Other risk factors for iatrogenic injury include causes of pelvic adhesion like the previous surgeries, 11 endometriosis, and prior radiation therapy, advanced abdominopelvic cancers, [12][13][14] enlarged uterus at hysterectomy, cervical fibroids, and broad ligament fibroids, limited experience of the surgeon, bleeding, and excessive use of diathermy, 3 and transvaginal retrieval of oocytes (TOVR). 15…”

“…1,3 In a case of an inadvertent laceration and the transection less than 50% of the diameter of the ureter, an end-toend anastomosis of the healthy portions of the damaged ureter is preferable to avoid post-operative persistent ureteral leak or stenosis. 1,14,19 This is followed by a ureteral stenting for 3-6 weeks and followed by an IVP as stated above.…”