[Treatment of iatrogenic ureteral injuries. A propos of 24 cases]

ABSTRACT

To evaluate the diagnosis and treatment of 24 patients with ureteral injury at our institution. In this retrospective study we evaluated 24 patients [22 females and 2 males] with ureteral injury treated at our institution between June 1993 and June 2005. The average age was 41 years [range 22-65 years]. the majority of ureteral injuries occurred during gynecological surgery [22/24 cases = 92%]. The time elapsed between the ureteral injury and diagnosis was 5 months on average; only in one case [3.8%], the injury was discovered during surgery. Four patients were treated endoscopically while ureteroscopy and end-to-end anastomosis was applied in 5 and open surgery in 15 cases. End-to-end ureterorraphy with placement of a double-J catheter was necessary in one patient, where endoscopic treatment had failed. After an average follow-up period on 60 months, loin pain had resolved in all cases. On radiological evaluation, a residual uretero-pyelocalyceal hyptony was noted in 5 cases and a satisfactory ureteral passage without strictures in the others. No nephrectomy was necessary in this series. Ureteral injury is most often secondary to gynecological surgery. In the majority of cases endourologic repair is the treatment of choice. It is recommended to pass ureteral catheters pre-operatively in order to ease the repair of the injury