Korean J Urol.  2007 Oct;48(10):1035-1039. 10.4111/kju.2007.48.10.1035.

Severe Iatrogenic Ureteral Avulsions Caused by the Ureteroscopic Procedures

• Seo EJ
• Kang TW
• Noh JH

• KMID: 2139735
• DOI: http://doi.org/10.4111/kju.2007.48.10.1035

Abstract

PURPOSE: We reviewed the incidence, causes, location, treatment and prognosis of the severe iatrogenic ureteral avulsions caused by ureteroscopy procedures.
MATERIALS AND METHODS
We analyzed the records of eight patients with ureteral avulsion out of 683 patients treated with ureteroscopic procedures, retrospectively. The patients had surgical correction or ureteral double-J stenting for the iatrogenic ureteral avulsions.
RESULTS
The incidence of ureteral avulsion was 1.17%. While seven cases occurred during ureteroscopic removal of a stone, five cases among them occurred during stone basketing and two cases occurred during insertion of the ureteroscope. Another case among eight avulsion cases occurred while removing the during an endopyelotomy for a ureteral stricture. Depending on the length of the ureteral avulsion, four cases were over 2cm, the patientsopen surgical repair for ureteral continuity restoration immediately; three cases, under 2cm, were treated with indwelling ureteral double J stents, and one case with an injury to the entire ureter was treated with a nephrectomy. The result of the surgical treatment as the initial treatment was good in all cases. On the other hand, among the three cases with an inserted ureteral double-J stent, one case had aresult and the other two developed hydronephrosis.
CONCLUSION
Careful attention to surgical techniques and awareness of risk factors and types of potential injuries are essential to reduce severe iatrogenic ureteral avulsions. Our reports suggest that open surgical repair is better than an indwelling ureteral double-J stent for patients with a ureteral avulsion.

Keyword

Iatrogenic; Ureter; Avulsion; Ureteroscopy

MeSH Terms

Constriction, Pathologic
Hand
Humans
Hydronephrosis
Incidence
Nephrectomy
Prognosis
Retrospective Studies
Risk Factors
Stents
Ureter*
Ureteroscopes
Ureteroscopy

Reference

1. Saidi MH, Sadler RK, Vancaillie TG, Akright BD, Farhart SA, White AJ. Diagnosis and management of serious urinary complications after major operative laparoscopy. Obstet Gynecol. 1996. 87:272–276.

2. Blandy JP, Badenoch DF, Fowler CG, Jenkins BJ, Thomas NW. Early repair of iatrogenic injury to the ureter or bladder after gynecological surgery. J Urol. 1991. 146:761–765.

3. Selzman AA, Spirnak JP. Iatrogenic ureteral injuries: a 20-year experience in treating 165 injuries. J Urol. 1996. 155:878–881.

4. Al-Awadi K, Kehinde EO, Al-Hunayan A, Al-Khayat A. Iatrogenic ureteric injuries: incidence, aetiological factors and the effect of early management on subsequent outcome. Int Urol Nephrol. 2005. 37:235–241.

5. Yea SH, Park YI. Iatrogenic ureteral injuries in pelvic surgery: a review of 12 cases. Korean J Urol. 1997. 38:939–944.

6. Levy BS, Soderstrom RM, Dail DH. Bowel injuries during laparoscopy. Gross anatomy and histology. J Reprod Med. 1985. 30:168–172.

7. Choi DJ, Oh BR, Ryu SB. Dalayed recognition of ureteral injury after gynecological laparoscopic surgery. Korean J Urol. 2000. 41:892–896.

8. Chang R, Marshall FF. Management of ureteroscopic injuries. J Urol. 1987. 137:1132–1135.

9. Gupta V, Sadasukhi TC, Sharma KK, Yadav RG, Mathur R, Tomar V, et al. Complete ureteral avulsion. ScientificWorldJournal. 2005. 5:125–127.

10. Huffman JL. Ureteroscopic injuries to the upper urinary tract. Urol Clin North Am. 1989. 16:249–254.

11. Kostakopoulos A, Sofras F, Karayiannis A, Kranidis A, Dimopoulos C. Ureterolithotripsy: report of 1000 cases. Br J Urol. 1989. 63:243–244.

12. Alapont Alacreu JM, Broseta Rico E, Pontones Moreno JL, Oliver Amoros F, Palmero Marti JL, Boronat Tormo F, et al. Complications of uretero-renoscopy. Actas Urol Esp. 2003. 27:692–699.

13. Daniels GF Jr, Garnett JE, Carter MF. Ureteroscopic results and complications: experience with 130 cases. J Urol. 1988. 139:710–713.

14. Lytton B, Weiss RM, Green DF. Complications of ureteral endoscopy. J Urol. 1987. 137:649–653.

15. de la Rosette JJ, Skrekas T, Segura JW. Handling and prevention of complications in stone basketing. Eur Urol. 2006. 50:991–998.

16. Assimos DG, Patterson LC, Taylor CL. Changing incidence and etiology of iatrogenic ureteral injuries. J Urol. 1994. 152:2240–2246.

17. Johnson DB, Pearle MS. Complications of ureteroscopy. Urol Clin North Am. 2004. 31:157–171.

18. Lask D, Abarbanel J, Luttwak Z, Manes A, Mukamel E. Changing trends in the management of iatrogenic ureteral injuries. J Urol. 1995. 154:1693–1695.

19. Lee TH, Shin JH. Management of iatrogenic ureteral injury. Korean J Urol. 1992. 33:505–509.

20. Ku JH, Kim ME, Park YH. Management of iatrogenic ureteral injuries with delayed diagnosis. Korean J Urol. 1998. 39:977–981.

21. Witters S, Cornelissen M, Vereecken R. Iatrogenic ureteral injury: aggressive or conservative treatment. Am J Obstet Gynecol. 1986. 155:582–584.

22. Silverstein JI, Libby C, Smith AD. Management of ureteroscopic ureteral injuries. Urol Clin North Am. 1988. 15:515–524.

23. Paick JS, Park MS, Lee CW. Ureteroureterostomy for the management of iatrogenic lower ureter injury. Korean J Urol. 1997. 38:151–157.

24. Watterson JD, Mahoney JE, Futter NG, Gaffield J. Iatrogenic ureteric injuries: approaches to etiology and management. Can J Surg. 1998. 41:379–382.