Percutaneous minimally invasive management of iatrogenic ureteral injuries.
OBJECTIVE
To present experience with the percutaneous management of iatrogenic ureteral injuries.


METHODS
Eighteen women and six men with a mean age of 59.3 years (range 33-80 years) received a diagnosis of ureteral injury sustained during gynecologic, urologic, and general surgical procedures. In a total of 25 injured ureters, 12 had interruption of continuity of their lumen, 10 were associated with contrast extravasation, and 3 were related to both. A standard percutaneous nephrostomy tract was established on the side of the afflicted kidney. Combined use of hydrophilic guidewires and balloon dilations were performed to achieve antegrade recanalization of the ureteral lesion. Then, a ureteral stent was inserted to assure patency.


RESULTS
Average stricture length was 1.21 (range 0.5-1.9 cm). Success of the aforementioned technique was possible in 18 ureters. Successful management in one session took place in 14 ureters. Average hospitalization time was 1.8 days (range 0-5 d). The follow-up period ranged between 12 and 18 months, with mean follow-up time of 12.9 months. Ureteral patency was evident at 1 week follow-up in six patients with obstructed ureters. In the remaining patients, balloon dilation of the stricture was repeated, and another stent was placed. Extravasation of contrast was observed in two patients with extravasating ureters in the same period. Nephrostomy tubes were removed after a mean indwelling period of 5.9 weeks (range 1-12 wks). Two patients treated by the described method died during their hospitalization in the intensive care unit because of sepsis from peritonitis that was related to colon injury and multiple concomitant injuries. Major complications were not observed in the remaining 22 patients during the follow-up period.


CONCLUSIONS
The minimally invasive management of ureteral injuries is a safe and efficient method for both ureteral obstruction and/or laceration in a wide range of iatrogenic ureteral injuries.
Koukouras
Dimitrios
D
Department of Surgery, University of Patras, Patras, Greece.
Petsas
Theodore
T
Liatsikos
Evangelos
E
Kallidonis
Panagiotis
P
Sdralis
Elias K
EK
Adonakis
Georgios
G
Panagopoulos
Constantinos
C
Al-Aown
Abhulrahman
A
Decavalas
Georgios
G
Perimenis
Petros
P
Siablis
Dimitrios
D
Karnabatidis
Dimitrios
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019990:Perioperative Care; D014513:Ureter / Q000293:injuries* / Q000473:pathology / Q000601:surgery*