A 4-years experience retrospective multicenter clinical study of iatrogenic ureteric injuries
A 4-years experience retrospective multicenter clinical study of iatrogenic ureteric injuries
DOI:
https://doi.org/10.53460/AMH712025.008الكلمات المفتاحية:
Ureteral injury، Ureteroneocystostomy.، Iatrogenic ureteral damage، Iatrogenic، Hysterectomy، Surgical Complication، Ureteroscopyالملخص
Abstract
Background: Iatrogenic ureteric injury is a serious surgical complication, leading to significant morbidity. Understanding its contemporary causes, diagnostic patterns, and management outcomes is crucial for improving patient care.
Aim: This study aimed to identify the etiology, management, and outcomes of iatrogenic ureteric injuries in a clinical series of 44 patients.
Methods: A retrospective, descriptive study was conducted on 44 patients with iatrogenic ureteric injuries treated between January 2020 and January 2024. Data on demographics, causative procedures, injury characteristics, diagnostic timing/modality, and treatment strategies were collected and analyzed using SPSS version 25.0. Statistical associations were assessed using Pearson's Chi-Squared test.
Results: The cohort had a female predominance (61.4%). Gynecological surgeries were the most common cause of injury (40.9%), followed by urological procedures (38.6%, predominantly ureteroscopy) and general surgeries (20.5%). The lower ureter was the most frequently injured site (52.3%). The most common injury types were perforation (29.5%) and ligation (27.3%). A significant association was found between the cause and type of injury (p<0.001), with ureteroscopy linked to perforations/avulsions and gynecological surgery to ligations. Diagnosis was immediate (intraoperative) in 47.7% of cases and delayed in 52.3%. Retrograde ureterography was the primary diagnostic modality (56.8%). Immediate diagnosis was significantly associated with less complex management (e.g., stenting), while delayed diagnosis necessitated more complex reconstruction (p=0.002). Treatment was tailored to the injury and included Double-J stenting (27.3%), ureteroureterostomy (13.6%), and ureteroneocystostomy (27.3%). A significant association was found between the site of injury and the type of surgical repair performed (p=0.015).
Conclusion: Iatrogenic ureteric injuries remain a significant challenge, most commonly caused by gynecological and urological procedures. The timing of diagnosis is a critical determinant of management complexity, with intraoperative recognition allowing for simpler, more effective repair. Adherence to procedure-specific preventive strategies and a high index of suspicion are essential to mitigate these injuries and optimize patient outcomes.
المراجع
Engelsgjerd JS, LaGrange CA. Ureteral Injury. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507817/
Burks FN, Santucci RA. Management of iatrogenic ureteral injury. Ther Adv Urol. 2014 Jun;6(3):115-24. doi: 10.1177/1756287214526767. PMID: 24883109; PMCID: PMC4003841.
Delacroix SE, Winters JC. Urinary tract injures: recognition and management. Clinics in colon and rectal surgery. 2010 May;23(02):104-12.
Ali, M.A., Maalman, R.SE., Oyortey, M.A. et al. A 6-year retrospective clinical review of iatrogenic ureteric injuries repaired in a resource-deprived setting. BMC Surg 22, 380 (2022). https://doi.org/10.1186/s12893-022-01817-3
Souli A, Alves A, Tillou X, Menahem B. Iatrogenic ureteral injury: What should the digestive surgeon know?. Journal of Visceral Surgery. 2024 Feb 1;161(1):6-14.
Al-Awadi K, Kehinde EO, Al-Hunayan A, Al-Khayat A. Iatrogenic ureteric injuries: incidence, aetiological factors and the effect of early management on subsequent outcome. Int Urol Nephrol. 2005;37(2):235-41. doi: 10.1007/s11255-004-7970-4. PMID: 16142549.
Maheswaran, R., Beisland, C., Bergesen, A.K. et al. A delayed diagnosis of iatrogenic ureteral injury results in increased morbidity. Sci Rep 14, 13771 (2024). https://doi.org/10.1038/s41598-024-63847-6
Lucarelli G, Ditonno P, Bettocchi C, Grandaliano G, Gesualdo L, Selvaggi FP, Battaglia M. Delayed relief of ureteral obstruction is implicated in the long-term development of renal damage and arterial hypertension in patients with unilateral ureteral injury. The Journal of urology. 2013 Mar 1;189(3):960-5.
Abboudi H, Ahmed K, Royle J, Khan MS, Dasgupta P, N'dow J. Ureteric injury: a challenging condition to diagnose and manage. Nature Reviews Urology. 2013 Feb;10(2):108-15.
Tyritzis SI, Wiklund NP. Ureteral strictures revisited… trying to see the light at the end of the tunnel: a comprehensive review. Journal of endourology. 2015 Feb 1;29(2):124-36.
Parpala-Spårman T, Paananen I, Santala M, Ohtonen P, Hellström P. Increasing numbers of ureteric injuries after the introduction of laparoscopic surgery. Scandinavian journal of urology and nephrology. 2008 Jan 1;42(5):422-7.
Elliott SP, McAninch JW. Ureteral injuries: external and iatrogenic. Urologic Clinics. 2006 Feb 1;33(1):55-66.
Ostrzenski A, Radolinski B, Ostrzenska KM. A review of laparoscopic ureteral injury in pelvic surgery. Obstetrical & gynecological survey. 2003 Dec 1;58(12):794-9.
Li X, Yang K, Ding G, Zou X, Ye L, Wu J, Zhang P, Fang D, Hao H, Li Z, Zhu H, Li X, Jiang H, Wang K, Zhou L, Li H. Etiology, characteristics and management of ureteric injury: experience from a nationwide study. Transl Androl Urol. 2022 Jun;11(6):794-802. doi: 10.21037/tau-21-998. PMID: 35812192; PMCID: PMC9262749.
Chalya PL, Massinde AN, Kihunrwa A, Simbila S. Iatrogenic ureteric injuries following abdomino-pelvic operations: a 10-year tertiary care hospital experience in Tanzania. World J Emerg Surg. 2015 Mar 12;10:17. doi: 10.1186/s13017-015-0011-z. PMID: 25774212; PMCID: PMC4359460.
Ouattara A, Pare AK, Kabore FA, Yameogo C, Ky D, Bayané D, Ye D, Kambou T. Iatrogenic ureteral injuries associated with gynecological and surgical procedures: our experience about 18 cases and literature review. Research and reports in urology. 2021 May 25:289-93.
Radu VD, Costache RC, Onofrei P, Banov P, Al Jaafari F, Vasilache IA, Socolov D, Radu R. Double-J Ureteral Stenting in Obstetrics and Gynecology: Pivotal or Problematic? J Clin Med. 2024 Dec 16;13(24):7649. doi: 10.3390/jcm13247649. PMID: 39768572; PMCID: PMC11676973.
Rassweiler JJ, Gözen AS, Erdogru T, Sugiono M, Teber D. Ureteral reimplantation for management of ureteral strictures: a retrospective comparison of laparoscopic and open techniques. European urology. 2007 Feb 1;51(2):512-23.
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