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Review
. 2014 Jun;6(3):115-24.
doi: 10.1177/1756287214526767.

Management of iatrogenic ureteral injury

Frank N Burks  1 , Richard A Santucci  2
Affiliations
Review

Management of iatrogenic ureteral injury

Frank N Burks et al. Ther Adv Urol. 2014 Jun.

Abstract

Iatrogenic injury to the ureter is a potentially devastating complication of modern surgery. The ureters are most often injured in gynecologic, colorectal, and vascular pelvic surgery. There is also potential for considerable ureteral injury during endoscopic procedures for ureteric pathology such as tumor or lithiasis. While maneuvers such as perioperative stenting have been touted as a means to avoid ureteral injury, these techniques have not been adopted universally, and the available literature does not make a case for their routine use. Distal ureteral injuries are best managed with ureteroneocystostomy with or without a vesico-psoas hitch. Mid-ureteral and proximal ureteral injuries can potentially be managed with ureteroureterostomy. If the distal segment is unsuitable for anastomosis then a number of techniques are available for repair including a Boari tubularized bladder flap, transureteroureterostomy, or renal autotransplantation. In rare cases renal autotransplantation or ureteral substitution with gastrointestinal segments may be warranted to re-establish urinary tract continuity. Laparoscopic and minimally invasive techniques have been employed to remedy iatrogenic ureteral injuries.

Keywords: iatrogenic; surgical management; trauma; ureter.

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Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Retrograde pyelogram illustrating a ureteral arterial fistula.
Figure 2.
Figure 2.
A tunneled ureteroneocystostomy for distal ureteral injury.
Figure 3.
Figure 3.
Vesico-psoas hitch for distal ureteral reimplantation.
Figure 4.
Figure 4.
Ureteroureterostomy: the ends of the ureters are trimmed and a running anastomosis is performed.
Figure 5.
Figure 5.
A Boari flap: a flap of bladder is fashioned into a tube and an anastomosis is created between it and the proximal ureter.
Figure 6.
Figure 6.
Transureteroureterostomy. (a) The donor ureter is tunneled through the mesentery. (b) End-to-side anastomosis of the donor ureter and recipient ureter. (c) The final transureteroureterostomy configuration.
Figure 7.
Figure 7.
(a) The ileal ueter kidney anastomosis. (b) The ileal ureter bladder anastomosis.
See this image and copyright information in PMC

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