Iatrogenic ureteral injury. Options in management
D. E. Fry, L. Milholen and P. J. Harbrecht
Twenty-five patients sustained 27 iatrogenic ureteral injuries during
various operative procedures. Injuries were managed by ureteroureterostomy
in 11 injuries, ureteroneocystostomy in 11, nephrectomy in two, ureteral
stent in one, cutaneous ureterostomy in one, and reimplantation into an
ileal conduit in one. Four of 25 patients died, three as a result of the
failure of ureteral repair and intra-abdominal sepsis. Short-term failure
of repair occurred in five patients; long-term failure occurred in three.
All patients with injuries missed during the primary operation had poor
results of ureteral reconstruction. Immediate recognition of accidental
ureteral injury provides optimum results. Injuries within 4 cm of the
ureterovesical junction are managed by ureteroneocystostomy; injuries
greater than 4 cm, by ureteroureterostomy. Crush injuries require immediate
placement of a ureteral stent. Prior pelvic radiotherapy or intra-abdominal
infection should preclude any attempt at primary reconstruction.
