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Endourological treatment of ureteric injuries
L Cormio1, M Battaglia, A Traficante
1Division of Surgical Nephrology, University of Bari, Italy.
Abstract:
Over the last 8 years, 30 patients with ureteric injuries underwent endoscopic treatment. There were 14 failures, 5 because of blockage or diversion of the catheter in the fistulous gap and 9 because it was impossible to penetrate the stenotic tract. All failures occurred when treatment was attempted more than 3 weeks after the trauma. Sixteen lesions were successfully treated by placing a 6 to 10 F double pigtail catheter in the damaged ureter and leaving it for at least 3 months. Patients were followed up for 24 months. No recurrences were seen and good long-term results were achieved in all cases. In our experience, endourological treatment can be recommended for recent strictures < 2 cm in length, or for small fistulas in which continuity of the ureteric wall is still partially preserved. Despite the risk of failure, especially following late treatment of an injury, it should be considered a safe and effective procedure that is accepted well by the patients and that avoids the need for open surgery and its possible complications.
Insights
Endoscopic treatment for ureteric injuries is effective for recent, short strictures or small fistulas. Early intervention yields successful long-term outcomes, avoiding open surgery.
Area of Science:
- Urology
- Endourology
Background:
- Ureteric injuries can lead to strictures or fistulas.
- Traditional open surgery poses risks and complications.
Purpose of the Study:
- To evaluate the efficacy of endoscopic treatment for ureteric injuries.
- To determine optimal candidates and timing for endourological intervention.
Main Methods:
- Retrospective analysis of 30 patients with ureteric injuries treated endoscopically.
- Placement of double pigtail catheters for at least 3 months.
- 24-month follow-up for recurrence and long-term outcomes.
Main Results:
- Successful endoscopic treatment in 16 out of 30 patients.
- 14 failures, primarily due to late treatment ( > 3 weeks post-trauma), catheter issues, or stenotic tract blockage.
- No recurrences observed in successfully treated patients with good long-term results.
Conclusions:
- Endourological treatment is safe and effective for recent ureteric strictures (< 2 cm) or small fistulas.
- Early treatment is crucial for success, with late interventions carrying a higher risk of failure.
- Endoscopic management offers a viable alternative to open surgery, with good patient acceptance.