[Changing trends of ureteral injuries]

Ureteral injury is a potential complication of any abdominal or pelvic surgery. Gynecological surgery has traditionally accounted for most injuries. In the last decade, there have been major advances in endoscopic surgery including ureteroscopy and laparoscopy, both of which may cause ureteral injury. Increased use of these procedures change the nature of ureteral injuries. From 1988 to 1997, 22 patients with 24 ureteral injuries were identified. The causes, diagnostic methods and treatments were reviewed. Ureteral injury was defined as any laceration, transection or ligation of the ureter that required an unexpected procedure for repair, stent or drainage. In 24 ureteral injuries, there were 20 unilateral cases and 2 bilateral cases eight men (33%) were 15 to 43 years old (mean age 30), and 14 women including 2 case of bilateral lesion (67%) were 30 to 75 years old (mean age of 46). The injuries were on the right side in 11 cases (46%), left side 13 cases (54%), and in the upper, and lower third of the ureter in 7 (29%) and 17 cases (71%), respectively. Bilateral injuries were all in the lower ureter and another 2 cases of lower ureteral injuries were combined with bladder injuries. In the cases of ureteral injuries, iatrogenic injuries accounted for 19 cases (79%). Of these, urological surgery, laparoscopic surgery, ureteroscopic procedures and gynecological surgery accounted for 1 (4%), 2(8%), 5(21%) and 11 cases (46%) respectively. Between 1988 and 1992, there were 7 cases, and after 1993, there were 17 cases of ureteral injuries. The injuries caused by trauma and gynecological surgery remained stable in the 2 period. The recent increases were caused by endoscopic procedures including ureteroscopy and laparoscopy. Of the 24 cases, 13 cases (54%) were managed by ureteroneocystostomy, 5 cases (21%) by nephrectomy, 4 cases (17%) by ureteroureterotomy, 1 case by PCN and 1 case by double-J catheter stenting only. The early recognition and repair at injury allow for better results with fewer complications. Delayed finding or commitant infection may lead to failure of reconstructive procedure and lead to nephrectomy.