Endoscopic realignment in the management of complete transected ureter

Abstract

Purpose: To present experience and feasibility of endoscopic realignment for treatment of delayed recognized iatrogenic complete transected ureteral injuries.

Patients and methods: Patients suffering from iatrogenic complete transected ureteral injuries were treated by two surgeons. Five women and 3 men with a mean age of 50.8 years (range 22-69) received diagnosis during the immediate postoperative period (2-6 days after surgery). Ureteral continuity was re-established using a technique combining antegrade flexible ureteroscopy and retrograde rigid ureteroscopy. Then, three ipsilateral 5F double J stents were inserted to assure ureteral patency.

Results: All eight realignment procedures were successful, and no major complications occurred. Average injury length was 1.9 cm (range 1.5-3.0). Average hospitalization time was 8 days (range 3-14). Nephrostomy tubes and stents were removed after a mean period of 3.9 weeks (range 2-6) and 6.8 months (range 5.9-7.1), respectively. At a mean follow-up of 21.5 months (range 10-56), 6 patients were stent-free without image evidence of obstruction, a patient developed strictures was treated with balloon dilation and another exchanged double J stents periodically. No patient has developed significant renal impairment.

Conclusion: Endoscopic realignment is a safe and efficient method as an initial procedure to manage iatrogenic complete transected ureteral injuries in properly selected cases.