Treatment of urological complications related to aorto-iliac pathology and surgery

Proximity of ureters with iliac arteries makes them prone to damage by aorto-iliac pathology or surgery. The aim of this retrospective study is to analyse the incidence, the predisposing factors, and the optimal treatment of ureteral stenosis (US) or leakages (UL).

Retrospective study.

Fifty-one ureteral lesions in 41 patients referred to the urologist in a fourteen years period in the same institution.

Lesions are classified in three groups: A, preoperative; B, less than 3 months postoperatively; and C, more than 3 months postoperatively. Group A comprises 10 abdominal aortic aneurysm (AAA) patients; eight of the AAA are of the inflammatory type. Group B comprises 16 patients, 11 US and 9 UL. Group C comprises 15 patients and 15 US.

Endoureteral treatment was successful in most of the group B patients. Some of them, however, had to be submitted to secondary open surgery, so that the global success rate is 70% in group B. In group C, the response is poor following endourological treatment alone (12.5% success) and open surgery is more often needed (3 ureterolyses and 1 nephrectomy). Global success rate is 40%.

Early diagnosis is associated to better results with less invasive procedure; late diagnosis is accompanied by a lower success rate of endourological treatment and requires more often primary open surgery.