Management of iatrogenic ureteral injury and fistula

ABSTRACT

Thirty-three patients with iatrogenic ureteral were treated over 8-year period. Gynecologic, urologic and abdominal operations were the antecedent procedures in 63.6%, 21.2% and 15.2%, respectively. The diagnosis was made immediately in 7 cases, concomitantly repaired and within the first 4 weeks in 24 cases all fistulating into the skin, vagina or the bowel and fixation of a double-j stent either through a retrograde or antegrade route was successful only in 6. Surgical repair after an average 4 weeks from percutaneous nephrostomy was successful in 18 cases, but 2 obstructive cases were repaired without diversion. Surgically induced ureteric injuries must be managed immediately and 25% of the fistulating cases can be treated only with ureteral stenting. Percutaneous nephrostomy in addition to fascilitating rerouting and stenting of ureteric fistula, have also a profound effect in minimizing obstructive changes and seepage of urine in all the cases. Furthermore it allows an earlier surgical repair with minimal fibrosis at the site of fistula