Management of iatrogenic ureteral injuries analysis report at urology department, Nishtar hospital Multan

ABSTRACT

To review the etiology, diagnosis and treatment of iatrogenic ureteral injuries. The study was carried out at Department of Urology, Nishtar Hospital, Multan from December 2007 to December 2010. A total of 24 adult patients were included in the study. All patients were evaluated in terms of clinical presentation, physical examination and investigations. Different techniques including open repair and endoscopic maneuvers were performed as treatment modalities for ureteric injuries. Out of 24 patients, 13 patients were female and 11 patients were males. Age of patients ranged from 20 years to 60 years. Out of 13 female patients, eleven developed lower ureteral injuries secondary to obstetrics and gynaecological procedures. Remaining two female patients had ureteral injuries following ureteroscopy for lower ureteral stones. Eleven female patients had different symptoms including partial or total incontinence of urine, flank pain, symptoms of UTI, high grade fever, sepsis, anuria and urinary leakage. Patients who underwent URS or URS in situ lithotripsy had lower ureteral stones. Most of them had lumbar pain, symptoms of UTI, frequency, urgency and difficulty in micturation. Two patients had retention of urine for which they were catheterized. One had broken segment of DJ stent. Different techniques were employed, ureter re-implantation for distal ureteral injuries was performed in ten patients. For minor lacerations and suspected urinary leakage following URS for stone disintegration at lower ureter, ureteric catheter or DJ stent was placed. latrogenic uretral injuries are rare following gynaecological, obstetrical and endourological procedures but are liable to occur due to inherent anatomic factors. Prompt diagnosis and institution of appropriate corrective surgical procedures often result satisfactory outcome: