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Diagnosis and Treatment of Iatrogenic Ureteral Injury

Review literature: (Elliott and McAninch, 2006) (Preston, 2000).

Causes of Iatrogenic Ureteral Injuries

Urological operations may jeopardize the ureter: ureteroscopy, radical prostatectomy, simple prostatectomy, transurethral resection of the prostate or bladder, pelvic or retroperitoneal lymphadenectomy. Frequent operations of other departments with a risk for ureteral injury are hysterectomy, colon, and vascular surgery.

Mechanisms of Ureteral Injury

Dissection, suture, ligature, contusion, devascularization, infection, or compression by hematoma or lymphocele.

Signs and symptoms

Flank pain, abdominal pain, fever, upper urinary tract obstruction, hematuria, urinoma, ascites, peritonitis, or urine secretion via the wound or vagina.

Diagnostic Workup

• Abdominal and renal sonography
• Intravenous urography, or better an abdominal computed tomography
• Cystoscopy and retrograde pyelography, if endoscopic treatment is deemed possible

Treatment of Iatrogenic Ureter Injury

Endoscopic Treatment

Endoscopic treatment is an option, if antegrade or retrograde placement of a ureteral stent is possible. Depending on the healing of the ureter, the ureteral stent can be withdrawn. In persisting ureteral stricture, surgical treatment is necessary. Percutaneous nephrostomy is an option when ureteral splinting is not possible.

Surgical Treatment

Indications for surgical treatment are frustrate endoscopic treatment, urinous ascites, ureteral-vaginal fistula, and persistent ureteral stricture after endoscopic treatment. Surgical reconstruction depends on the location and extent of the ureteral injury, see next section persisting ureteral stricture. Final reconstruction must be postponed until the patient is in good condition, e.g., after peritonitis, sepsis or shock. Depending on the circumstances, a two-stage procedure after the insertion of a percutaneous nephrostomy may be wise.

References

  Deutsche Version: Traumatische und iatrogene Verletzung des Harnleiters