Abstract
The ureter is vulnerable during general, gynecologic, and urologic surgeries. The traditional open surgical approaches to treating the iatrogenic ureteral injuries have shown several disadvantages such as relatively high rate of severe complications. Although the applications of endourological techniques for management of lower ureteral strictures have been routinely introduced over the last 10 years, most of the different modalities were based on the utilization of hydrophilic instruments that can facilitate the traversal of strictures surrounded by the sutures with gradually increasing force. Interestingly, we have revealed the Ho:YAG laser as the outstanding auxiliary approach to incising the sutures during the ureteroscopy for its well-controlled penetration depth, minimal scarring, and precise cutting. As far as we know, the combined utilization of Ho:YAG laser to incise the sutures responsible for the strictures and double J ureteral stent for drainage has not been extensively reported. Normal ureters of the patients managed by this novel approach were shown by the follow-up 3-4 months later, which demonstrated that the available technique was promising to effectively treat the iatrogenic ureteral injuries.
Highlights
Despite the ongoing advances in modern surgical techniques, the unexpected iatrogenic ureteral injuries still represent one of the most serious postoperative complications in intra-abdominal, retroperitoneal, or pelvic operations with significant morbidity due to the possible impairment of renal function and susceptibility to microbial pathogens [1, 2]
The abovementioned traditional open surgical techniques are somehow no longer widely accepted as options for the management of iatrogenic lower ureteral injury, as some reports have associated ureteroureterostomy with a relatively high rate of severe complications, the issue is still controversial [10, 11]
From October 2009 to May 2013, 12 patients (11 females and one male with average age of 48.8 years and range from 37 years to 68 years) had been postoperatively detected to have iatrogenic lower ureteral injuries sustained during general, gynecologic, and urologic procedures. These patients (9 left side ureteral lesions, 3 right side ureteral lesions; 8 cases of iatrogenic ureteral injury occurred in radical hysterectomy, 3 cases occurred in resection of rectal cancer, and 1 occurred in the radical resection of uterine recurrent tumor, Table 1) presented to our department with the postoperative symptoms related to hydronephrosis and/or compromised renal function
Summary
Despite the ongoing advances in modern surgical techniques, the unexpected iatrogenic ureteral injuries still represent one of the most serious postoperative complications in intra-abdominal, retroperitoneal, or pelvic operations with significant morbidity due to the possible impairment of renal function and susceptibility to microbial pathogens [1, 2]. The abovementioned traditional open surgical techniques are somehow no longer widely accepted as options for the management of iatrogenic lower ureteral injury, as some reports have associated ureteroureterostomy with a relatively high rate of severe complications, the issue is still controversial [10, 11]. Another reason for ureteroureterostomy rarely being introduced to repair lower ureteral injury was that distal ureters had a relatively poor vascular and blood supply while the pelvic ureter appears to have a high preponderance of plexiform vessels, which has been considered susceptible to ischemia after transection [12]. Laparoscopic reconstructions of ureteral injuries have been introduced in the clinical practice, and the experience is International Scholarly Research Notices
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