Analysis of diagnosis and treatment effect of iatrogenic ureteral injury and the vulnerable sites
10.3760/cma.j.cn112330-20221026-00568
- VernacularTitle:输尿管医源性损伤的部位和修复效果
- Author:
Dilixiati DILIYAER
1
;
Rexiati MULATI
;
Laihaiti DUOLIKUN
;
Weijie ZHANG
;
Azhati BAIHETIYA
Author Information
1. 新疆医科大学第一附属医院泌尿中心 新疆泌尿男生殖系疾病临床医学研究中心，乌鲁木齐 830054
- Keywords:
Ureteral injuries;
Iatrogenic;
Surgical treatment;
Injury site
- From:
Chinese Journal of Urology
2024;45(6):456-460
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To examine the location and the reparative impact of iatrogenic ureteral injury.Methods:Retrospectively analyzed the clinical data of 43 patients with iatrogenic ureteral injury admitted from May 2019 to May 2022. The median age of the patients was 39 years. The injuries were predominantly on the left side in 26 patients (60.5%), in addition, there were 16 patients (37.2%) on the right side, and 1 patient on(2.3%)bilateral sides. The types of injuries were upper ureteral (8 patients, 18.6%), middle ureteral (8 patients, 18.6%), and lower ureteral (27 patients, 62.8%). The average injury length was 5.9 cm with a standard deviation of 2.4.During intraoperative diagnosis, 7 cases were found to have damage, transection, or ligation of the ureteral luminal structure. Surgical areas displayed extensive exudation and the presence of adipose tissue was observed during ureteroscopy. There were 36 cases manifested symptoms such as lumbar and abdominal pain (13 cases), fever (12 cases), peritoneal irritation sign (9 cases), vaginal discharge (9 cases), or hematuria (5 cases). Among these cases, 10 showed contrast agent spillage on urinary enhanced CT or intravenous urography, while 27 exhibited hydronephrosis or ureteral dilatation. Additionally, one case presented a renal tumor on the affected side, and creatinine examination was performed on drainage fluid in 7 cases. Furthermore, a unilateral renal nonfunction was identified in 1 case through renal ECT examination.Results:Out of the 43 patients followed up for a median of 18 months (range 11-47), 41 patients had no urinary symptoms such as hematuria, urine extravasation, or hypochondriac pain. Their urine tests (routine, urea nitrogen, and serum creatinine) were normal. Thirteen patients showed mild hydronephrosis on urinary ultrasonography, which remained stable during the follow-up period. One patient experienced restenosis at the ureterovesical anastomosis after renal autograft transplantation, but symptoms improved after balloon dilatation. Another patient underwent nephrostomy puncture and was found to have a clamped left ureteral end and a fistula in the sigmoid colon. This patient successfully underwent bilateral ureteroneocystostomy with a bladder flap and had a positive postoperative outcome.Conclusions:Iatrogenic ureteral injuries occur at seven specific sites, with gynecological surgeries posing a higher risk of injury at the ureter and external iliac artery, pelvic infundibulum ligament, and uterine artery intersection or adjacent areas. Similarly, colorectal surgeries can result in injury at the parallel segment of the ureter and mesenteric vessels, colon adjacent region, and vas deferens intersection. Urological surgeries are more likely to cause injury at the intersection of the ureter and external iliac artery, as well as the ureteropelvic junction.When treating ureteral injuries, it is important to consider the cause, location, and length of the injury. For short and deep injuries, options such as ureteral anastomosis or ureterovesical anastomosis may be considered. In cases of longer injuries, alternatives like renal autograft transplantation, ureteral surgery involving other tissues, or techniques such as the Boari flap or buccal/oral mucosal transplantation can be explored. The primary focus during repair surgeries should be on achieving tension-free anastomosis while maintaining sufficient blood supply to the ureter and placing it in an area with better blood circulation.
