title: Non-surgical treatment of latrogenic postoperatively diagnosed ureteral injuries.
abstract: BACKGROUND
  latrogenic ureteral injury may be seen following abdominopelvic surgeries. While ureteral injuries identified during surgery should be immediately and surgically repaired, those that are postoperatively diagnosed may be treated non-surgically by draining the ipsilateral kidney. Data regarding the outcome of this approach are still missing.
  
  
  OBJECTIVE
  To evaluate the success rates of non-surgical management of ureteral injuries diagnosed following abdominopelvic surgeries.
  
  
  METHODS
  We retrospectively reviewed the files of all patients treated for iatrogenic ureteral injuries diagnosed following abdominopelvic surgeries. Patients' ipsilateral kidney was percutaneously drained following diagnosis of injury by either nephrostomy tube (NT)/nephro-ureteral stent (NUS) or double-J stent (DJS) inserted retrogradely. The tube was left in place until a pyelogram confirmed healing or a conservative approach was abandoned due to failure.
  
  
  RESULTS
  Twenty-nine patients were identified as having ureteral injury following abdominopelvic surgery. Median time from injury to renal drainage was 9 days, interquartile range (IQR) 4-17 days. Seven cases (24%) had surgical repair. Among the other 22 patients, in 2 oncology patients the conservative approach was maintained although renal drainage failed to resolve the injury. In the remaining 20, median drainage length was 60 days (IQR 43.5-85). Calculated overall success rates following renal drainage was 69% (18/29), and with NUS approached 78.5%.
  
  
  CONCLUSIONS
  Ureteral injuries diagnosed following abdominopelvic surgeries can be treated conservatively. Ipsilateral renal drainage should be the first line of treatment before surgical repair, and NUS may be the preferred drainage to obtain spontaneous ureteral healing.
authors.forename: Dorit E
authors.initials: DE
authors.lastname: Zilberman
authors.forename: Uri
authors.initials: U
authors.lastname: Rimon
authors.forename: Roy
authors.initials: R
authors.lastname: Morag
authors.forename: Harry Z
authors.initials: HZ
authors.lastname: Winkler
authors.forename: Jacob
authors.initials: J
authors.lastname: Ramon
authors.forename: Yoram
authors.initials: Y
authors.lastname: Mor
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000628:therapy*; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D010388:Pelvis / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D016896:Treatment Outcome; D014463:Ultrasonography; D014513:Ureter / Q000293:injuries*; D014567:Urography / Q000379:methods