Spontaneous Healing of Iatrogenic Complete Ureteric Transection Injury.

Hani Sayedin,Mohammad Al-Machhour

doi:10.7759/cureus.19440

Abstract

Iatrogenic ureteric injury is the most common cause of ureteric injury. It is usually caused by either gynecological or urological surgical procedures. Iatrogenic ureteric injury repair depends mainly on the time of diagnosis. We represent here a case of iatrogenic complete transection ureteric injury resulted from laparoscopic bilateral salpingo-oophorectomy. The patient had a history of abdominal hysterectomy causing adhesions that resulted in challenging surgery. One week later, the patient presented to the emergency department with abdominal pain, and contrast CT showed left hydronephrosis with extravasation of the contrast at the left renal pelvis. The patient was treated initially with left nephrostomy and an antegrade nephrostogram confirmed the diagnosis of complete transection ureteric injury. Surprisingly, left retrograde study, which was done 11 weeks after the operative injury, showed healing of the ureteric injury with a small annular stricture. The stricture was dilated and a stent was inserted. We concluded that conservative waiting and delayed ureteric repair might be advised in similar injuries allowing time for resolution of the postoperative inflammatory reaction and spontaneous healing.

Highlights

The ureter might be protected by its small size and the surrounding structures including viscera, pelvic bony wall, and back muscles
We represent here a case of iatrogenic complete transection ureteric injury resulted from laparoscopic bilateral salpingo-oophorectomy
The patient was treated initially with left nephrostomy and an antegrade nephrostogram confirmed the diagnosis of complete transection ureteric injury

Summary

Introduction

The ureter might be protected by its small size and the surrounding structures including viscera, pelvic bony wall, and back muscles. In mid and upper ureteric injuries, variable reconstructive techniques could be performed depending on the defect size, the level of injury, and surgical preference, including ureteroureterostomy, Boari flap, transureteroureterostomy, renal autotransplantation, and ureteral substitution with ileal segment [6]. Most of these reconstructive surgeries are complex procedures with relatively high index postoperative complications including leakage, stricture, and deterioration of the renal unit function. Considering the recent pelvic surgery, immediate diagnosis of left ureteric iatrogenic injury was concluded, and the patient was managed initially with urgent CT-guided nephrostomy insertion. The ureteroscopy showed a small annular stricture, less than 0.5 cm, that was passed over the safety guidewire and a ureteric stent, size 8 French, was inserted successfully

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