Ureteric injuries. Clinical and experimental studies

Area of Science:

• Urology
• Surgical Innovation
• Medical Device Research

Background:

• Ureteric injuries require effective management strategies.
• Identifying prognostic factors is crucial for optimal treatment selection.
• Current endourological treatments and stent materials have limitations.

Purpose of the Study:

• To establish guidelines for managing ureteric injuries.
• To evaluate prognostic factors influencing treatment outcomes.
• To assess the efficacy of endourological treatment and novel surgical techniques.
• To determine the safety and performance of double-J ureteric stent materials.

Main Methods:

• Clinical studies analyzed 137 ureteric injuries to identify prognostic factors (radiotherapy, treatment time, injury characteristics).
• Endourological treatment feasibility and efficacy were assessed in 30 injuries.
• A novel bladder Z-plasty technique for ureteric injury repair was developed and tested in sheep.
• In vivo and in vitro studies evaluated the safety and performance of various double-J ureteric stent materials.

Main Results:

• Injury length was the most significant prognosticator; previous radiotherapy and delayed treatment also negatively impacted outcomes.
• Endourological stenting succeeded in 16 of 30 cases, achieving good long-term results, particularly for short, early injuries.
• Bladder Z-plasty provided greater elongation than psoas-hitch without complications.
• Silicone and Hydro-Plus stents demonstrated better safety profiles compared to polyurethane, though silicone showed higher encrustation rates.

Conclusions:

• Injury length, radiotherapy, and treatment timing are critical for managing ureteric injuries.
• Endourological treatment is a viable option for specific ureteric injuries.
• Bladder Z-plasty offers a promising alternative for extensive ureteric repairs.
• Careful selection of double-J stent materials is essential to minimize adverse effects on renal function and urinary tract health.