Management of iatrogenic ureteral strictures after urological procedures

At our institution more of the iatrogenic ureteral injuries seen are caused by urologists than by gynecologists or general surgeons. The management of 94 such injuries is discussed, 55 of which were the result of open operations, 34 of endourological procedures and 5 of transurethral operations. More than half of the injuries (52 per cent) involved the ureteropelvic junction. Endourological procedures were successful in correcting the problem in 58 patients and consisted of endopyelotomy (38), dilation (10), ureteral meatotomy (8), antegrade ureterotomy (1) and percutaneous ureterotomy (1). Endourological procedures failed in 20 other cases. Altogether, 36 patients (38 per cent) required an open operation consisting of ureteroureterostomy (9), ureterocalicostomy (7), ureteral reimplantation (6), Boari flap (5), pyeloplasty (4), ileal interposition (3), undiversion (1) and nephrectomy (1). The treatment options that appear to be most suitable for particular types of injury are discussed. Final results were satisfactory in all patients.