Abstract
BackgroundEndoscopic operations and ureteroscopy have become the first choice for ureteral calculi and ureter-related operations. The ratios of the complications, which are mostly iatrogenic, range between 9 and 11%. Total ureteral avulsion during URS is quite rare with a prevalence of 0–0.3%. We present three total ureteral avulsions we experienced in our clinic during the last 2 years and their treatment.Case presentationDuring the last 2 years, we experienced three total ureteral avulsions: one of these occurred in our clinic and the other two occurred in an external center and were referred to us. In two cases, the omental flap was rotated after ureteral reimplantation and the ureter was completely wrapped inside the omental flap. In the third case, boari flap was formed from the bladder. Due to the presence of extrarenal wide renal pelvis, anastomosis was made with boari flap after a y–v flap was rotated on the renal pelvis. D-J stents of the patients were removed at the end of 3 months. Although there was mild hydronephrosis, parenchymal thinning and a significant decrease in functions were not observed. Ureteral avulsion of the patients was successfully managed without the need for nephrectomy.ConclusionUreteral avulsion management is an extremely difficult condition for both the surgeon and the patient. So, the most important thing is to prevent ureteral avulsion. Ureteroplasty and omental flap treatment are applicable methods with quite successful results for complete ureteral avulsions.
Highlights
Endoscopic operations and ureteroscopy have become the first choice for ureteral calculi and ureterrelated operations
Management of ureteral avulsion is a difficult condition, while end-to-end anastomoses constitute a good option for proximal ureteral avulsions, boari flap and psoas hitch methods are suggested if ureteral avulsion is in the middle one-third section
We present three total ureteral avulsions experienced in our clinic during the last 2 years and their treatments
Summary
Ureteral avulsion management is an extremely difficult condition for both the surgeon and the patient. The most important thing is to prevent ureteral avulsion. Refraining from sharp and hard manipulations is a necessity in upper ureteral calculi and/or patients who previously had treatment like ESWL. Refraining from basket use as much as possible and maybe above all, inserting D-J stent in difficult conditions without forcing calculi and ureter or delaying to another session could be the best solution. Despite all precautions and experience, ureteral avulsion is a risk always faced by urologists. In cases of ureteral avulsion, the patient should be referred to experienced centers in this field and the condition should successfully be managed without panic. Ureteroplasty and omental flap treatment is an applicable method for complete ureteral avulsions with quite successful results
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