Incidence Of Ureteral Injury Research Articles

Can Radiological Imaging Accurately Predict the Length of the Ureteral Defect/Stricture Following Ureteral Injury?

The incidence of ureteral injury is increasing due to extensive application of the endourological procedures. In the present study, we evaluated the accuracy of imaging studies in predicting length of defect in patients with ureteral injury. We reviewed data of all consecutive patients who underwent endourological management for ureteral injury in our institution from Jan 2020 to Jan 2023, to assess the accuracy of radiological evaluations in determining the length of ureteral defect. We compared the radiological imaging results with intraoperative findings to determine its diagnostic accuracy. We report data on accuracy of preoperative imaging and outcomes of endourological management in 5 patients who presented with apparently long ureteral defects in preoperative radiological evaluations following ureteral injury. The mean age was 42[30.5-42.5]. three of five were male. The mean time from injury to ureteroscopic management was 12.5±7.5 days. The mean follow up time was 7.3±2.2 months. Our experience showed that radiological evaluations have the potential to overestimate the length of defect. Radiological evaluations following ureteral injury have the potential to overestimate the length of defect and therefore endoscopic evaluations and intraoperative imaging studies are necessary to accurately determine the length of defect and appropriate management. However, endourological management is safe and efficient in treating patients with short segment ureteral defect/injury.

Prospective comparison of extracorporeal shock wave lithotripsy and ureteroscopy in distal ureteral stones.

The optimal treatment modality of distal ureteral stones is controversial. Therefore, we conducted a prospective study to evaluate the efficacy, safety, and cost of early second shock wave lithotripsy (SWL) sessions versus ureterorenoscopy (URS) in patients with distal ureteral stones.This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent SWL or URS for distal ureteral stones were enrolled in this study. The stone-free rate (SFR), secondary treatment rate, complications, and costs were recorded. Propensity-score matching (PSM) analysis was also performed. A total of 1023 patients were included, of whom 68.4% (700) were treated with SWL and 31.6% (323) with URS. Based on PSM, SWL had an equivalent SFR (87.4% vs. 84.9%,P = 0.325) at one month after SWL and secondary treatment rate (10.7% vs.10.8%,P = 0.958) when compared with URS. Complications were rare and comparable between the SWL and URS groups (6.0% vs. 5.9%,P > 0.05), while the incidence of ureteral injuries (i.e., perforations) was higher in the URS group compared with the SWL group (1.3% vs. 0%,P = 0.019). The hospital stay was significantly shorter (1day vs. 2days,P < 0.001) and the costs considerably less (2000 RMB vs. 25,030 RMB;P < 0.001) in the SWL group compared with the URS group. This prospective study demonstrated that early second SWL sessions had equivalent efficacy in addition to reduced complication rates and costs compared with URS in patients with distal ureteral stones. Our findings may help guide clinical decision making.

Comparison of shock wave lithotripsy and ureteroscopy in patients with proximal ureteral stones under the COVID-19 pandemic.

To compare the effectiveness, safety, and cost between ultrasound-guided shock wave lithotripsy (SWL) with an early second session protocol and ureteroscopy (URS) in patients with proximal ureteral stones using the propensity score matching (PSM) method based on a large prospective study. This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent lithotripsy (SWL or URS) for proximal ureteral stones were enrolled. The stone-free rate (SFR), complications, and cost were recorded. PSM analysis was performed. A total of 1230 patients were included, of whom 81.1% (998) were treated with SWL and 18.9% (232) were treated with URS. After PSM, the SWL group had an equivalent SFR at one month (88.7 vs. 83.6%, P = 0.114) compared with the URS group. Complications were rare and comparable between the two groups, while the incidence of ureteral injuries was higher in the URS group compared with the SWL group (1.4 vs. 0%,P = 0.011). The hospital stay was significantly shorter (1day vs. 2days,P < 0.001), and the cost was considerably less (2000 vs. 25,053,P < 0.001) in the SWL group compared with the URS group. This prospective PSM cohort demonstrated that ultrasound-guided SWL with an early second session protocol had equivalent effectiveness but better safety and lower cost compared with URS in the treatment of patients with proximal ureteral stones, whether the stones were radiopaque or radiolucent. These results will facilitate treatment decisions for proximal ureteral stones.

Fluorescence ureteral navigation during laparoscopic surgery for clinically suspected stage T4 colorectal cancer: A cohort study

BackgroundApproximately 15% of patients with colorectal cancer present with locally advanced tumors (T4 stage). Laparoscopic surgery for stage T4 disease has not yet been established.The near-infrared ray catheter fluorescent ureteral catheter (NIRFUC) is a new device that uses near-infrared fluorescence resin.We examined the utility of fluorescence ureteral navigation (FUN) with the NIRFUC during laparoscopic surgery for stage T4 colorectal cancer. Materials and methodsPatients with stage T4 colorectal cancer (n = 143, from January 2017 to March 2021) were divided into a T4FUN + group, in which the NIRFUC was used (n = 21), and a T4FUN- group, in which the NIRFUC was not used (n = 122). Short-term outcomes were compared between the groups.Next, the laparoscopic surgery rate and incidence of ureteral injury from January 2017 to March 2021 were compared between the T4FUN- group and the non-stage T4FUN- group (n = 434, from January 2017 to March 2021), in which fluorescence ureter navigation was not used. ResultsRectal cancer, stage T4b disease, and invasion into the urinary tract were observed more often in the T4FUN + group than in the T4FUN- group.In the comparisons of the T4FUN + versus T4FUN- groups, the operative time was 398 (161–1090) vs. 256 (93–839) minutes, the blood loss was 10 (1–710) vs. 25 (0–1360) ml, and the ratio of laparoscopic surgery to open surgery was 21:0 vs. 79:43. Postoperative complications (Clavien-Dindo grade ≥ III) were present in 2 (10%; 0 ureteral injury) patients in the T4FUN + group and 13 (11%; 2 ureteral injury) patients in the T4FUN- group.In the T4FUN + group, the operative time was longer (p < 0.0001), but the laparoscopic ratio was higher (p = 0.0002), and the blood loss volume and incidence of ureteral injury tended to be lower.In the comparisons of the T4FUN- versus non-stage T4FUN- groups, the ratio of laparoscopic surgery to open surgery was 79:43 vs. 384:50, the incidence of open conversion was 8 (6.6%) vs. 15 (3.5%), and the incidence of ureteral injury was 2 (1.6%) vs. 0 (0%). In the T4FUN- group, the open surgery rate (<0.0001), open conversion rate (p = 0.0205) and incidence of ureteral injury (p = 0.0478) were high, with a significant difference observed between the groups. ConclusionPatients with stage T4 disease have an increased risk of ureteral injury and are more likely to be converted to open surgery.FUN can help to safely increase the laparoscopic surgery rate while safely visualizing the ureter. FUN is recommended for laparoscopic surgery in patients with stage T4 colorectal cancer. Clinical trial registrationExamination of fluorescence navigation for laparoscopic colorectal cancer surgery; Research Ethics Committee of the Kawaguchi Municipal Medical Center (Saitama, Japan) approval number: 2020-3. https://kawaguchi-mmc.org/wp-content/uploads/clinical research-r02.pdf;

Very Low Rates of Ureteral Injury in Laparoscopic Hysterectomy Performed by Fellowship-Trained Minimally Invasive Gynecologic Surgeons

<h3>Study Objective</h3> The incidence of ureteral injury with laparoscopic hysterectomy reported in the literature is 0.78%. The objective of this study was to evaluate the rates of ureteral injury at the time of laparoscopic hysterectomy among high-volume fellowship-trained surgeons. <h3>Design</h3> We performed a retrospective chart review, evaluating gynecologic surgery cases between January 2009 and May 2019 performed exclusively by fellowship-trained surgeons in the Minimally Invasive Gynecologic Surgery (MIGS) Department at Harvard Medical School teaching hospitals in Boston. The rate of ureteral injury was assessed. <h3>Setting</h3> Patients were positioned in dorsal lithotomy with legs in Allen stirrups. A central (typically umbilical) camera port was placed along with bilateral lower quadrant ports and a third ipsilateral port to the left of the umbilicus. <h3>Patients or Participants</h3> A total of 5,160 cases were performed by MIGS surgeons between 2009-2019 at Brigham & Women's Hospital and Brigham & Women's Faulkner Hospital. Patients undergoing laparoscopic hysterectomy were selected for this review. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Out of the 5,160 MIGS cases, 2,396 laparoscopic hysterectomies were performed. Only 1 ureteral injury was noted intraoperatively (0.04%). No additional delayed ureteral injuries were observed. <h3>Conclusion</h3> Ureteral injury is associated with significant patient morbidity and high economic burden. Despite taking on medically and surgically complex cases at our tertiary referral center, we observed very low rates of ureteral injury at the time of laparoscopic hysterectomy. Putting this into context given that approximately 600,000 hysterectomies are performed annually in the US; the literature-reported ureteral injury rate would result in approximately 4,680 injuries versus an estimated 240 injuries in a high-volume center. This study highlights the benefits of fellowship-training and high-volume practice on patient outcomes.

Ureteric Injuries after Hysterectomy in a Tertiary Care Center of Nepal: A Descriptive Cross-sectional Study.

Pelvic surgery is the most common cause of iatrogenic ureteral injury. The incidence of ureteric injuries varies between skilled and inexperienced surgeons. The study aims to determine the prevalence of ureteric injuries sustained during hysterectomy in a tertiary care center of Nepal. A descriptive cross-sectional study involving the women attending the gynecological outpatient department of a tertiary care center of Nepal, for various benign and malignant conditions and later on underwent hysterectomy from June 2019 to June 2020 was done after obtaining ethical clearence from the Institutional Review Committee (Reference No. 245). Convenient sampling method was used. The data were entered in Excel and analyzed using Statistical Package for Social Sciences version 17. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Altogether, 1 (0.63%) (0.55-0.71 at 95% Confidence Interval) out of 159 patients sustained the ureteric injury during hysterectomy in a tertiary care center of Nepal. The injury was seen during the exploratory laparotomy for adnexal mass. The injury was recognized intraoperatively and was repaired with double J stenting. A total of 159 patients were enrolled in the study that had undergone hysterectomy over one year for various benign and malignant conditions. Out of which 21 (13.2%) had undergone surgeries for malignant conditions and 138 (86.79%) for benign conditions. Iatrogenic ureteric is still a major cause of harm and concern in hysterectomy. Patients with ureteric injury should be evaluated and intervened at the earliest.

Does prophylactic ureteric stenting at the time of colorectal surgery reduce the risk of ureteric injury? A systematic review and meta-analysis.

Cystoscopic placement of ureteric stents during colorectal surgery (CRS) may aid in the intraoperative identification of the ureters and thus prevent ureteric injury, but may also be associated with prolonged operating time, increased cost and adverse events. No formal recommendations exist regarding the use of ureteric stents prior to CRS. Our aim was to determine the effect of prophylactic ureteric stent insertion on the risk of ureteric injury among adult patients undergoing CRS. A systematic search using the Ovid platform was completed. The primary outcome was risk of ureteric injury. Secondary outcomes included the risk of acute kidney injury (AKI), urinary tract infection (UTI), sepsis, length of stay (LOS) and mortality. The Paule-Mandel pooling and a random effects model was used to produce odds ratios (ORs) with 95% confidence intervals (CIs) for binary outcomes. Standardized mean differences (MD) were reported for continuous variables. Analyses were completed using R3.5. Nine retrospective cohort studies evaluating 98507 patients were included. The incidence of ureteric injury was 0.6%. Overall, 5.1% of patients underwent ureteric stenting. There was no change in the odds of ureteric injury among stented patients compared with controls (OR 1.30, 95% CI 0.39-4.29, I2 =25%). Operating time was significantly longer (MD 49.3min, 95% CI 35.3-63.4, I2 =96%) in the intervention group. There was no difference in rates of AKI, UTI, sepsis, LOS or mortality between groups. Given the retrospective nature of the identified studies, the benefit of prophylactic ureteric stenting remains uncertain. Prophylactic ureteric stenting was not associated with increased patient morbidity but did significantly increase operating time.

Prophylactic ureteric catheterization before pelvic surgery in Rajavithi Hospital

Objective: To evaluate the incidence and the correlation between the risk factors of ureteric injury and complications in patients who underwent prophylactic ureteric catheterization before pelvic surgeries. Material and Method: From October 2015 to December 2018, the medical records of 130 patients in Rajavithi Hospital who underwent pelvic surgeries and prophylactic ureteric catheterization were retrospectively reviewed. Information included age, history of previous pelvic surgeries, pelvic radiation, presence of hydronephrosis, pathology, stage of cancer, injury of ureters, and complications. Results: Incidence of ureteric injury was 4.6% (n=6). The significant risk of injury was location of the tumor at the ovary (p=0.034); borderline significant risk was malignant pathology (p=0.057). After the procedure, 16.2% (n=21) of the patients had gross hematuria and 14.6% (n=19) of the patients had a urinary tract infection. Average time of catheterization was 20.95 minutes. Significant risk of gross hematuria was older age (p&lt;0.001) and malignant pathology (p=0.006). Conclusion: From this study, ureteric injury may be significantly higher in cases of malignancy at the ovary and may not prevent injury in high-risk patients. Ureteric catheterization should be carefully considered in elderly patients because of the higher rate of complications.

Risk of ureteric injury during ipsilateral uterosacral ligament vault suspension with intra-operative cystoscopy

Background: Post hysterectomy vaginal vault prolapse (PHVVP) occurs in up to 40% of women following hysterectomy. Many authorities recommend a procedure such as uterosacral ligament vault suspension (ULVS) is performed alongside hysterectomy to prevent future PHVVP. However, there is a concern that ULVS increases the risk of ureteric injury. The incidence of ureteric injury during ULVS is unknown but may be underestimated by studies which do not employ a reliable technique to detect ureteric complications. Here we present a large case series detailing outcomes from transvaginal ULVS.

Laparoscopic Versus Conventional Open Method for the Surgical Staging of Endometrial Carcinoma: A Comparative Study

Introduction: Before the advancement and improvement of techniques of using laparoscopy in total hysterectomy, it was considered as a procedure that carried a high risk of injury to the ureters but now with improvement of the experience, training and novel equipment, there is increase in the use of such procedure with lower incidence of ureteric injury. Recently, in surgical staging of endometrial carcinoma (EC); the laparoscopy role has been considered more beneficial. Many previous reports proved fewer complications, lower morbidity, shorter duration of postoperative hospitalization, and rabid recovery. But, the therapeutic benefits and drawbacks of using laparoscopy are not confirmed yet. Aim: The aim of current study was to assess the benefits and drawbacks of using laparoscopy in surgical staging of EC and comparing them with open surgical staging (laparotomy). Materials and Methods: the current study included 50 patients diagnosed with EC were included and were divided in to two groups the first group included 20 patients and was managed by laparoscopic staging, while the second group included 30 patients and was managed by laparotomy. We compared between using laparoscopy in surgical staging of EC with open surgical staging (laparotomy) regarding operative and postoperative outcomes. Results: laparoscopic method of staging had a significantly longer time of the operation than laparotomy (p=0.04), but it had lesser amount of blood loss intra-operatively (p<0.002). There were fewer number of resected lymph nodes (p=0.004) in the laparoscopic technique in contrast to laparotomy. Patients who underwent laparoscopy has a shorter time of postoperative staying in hospital in comparison to those who underwent laparotomy (p=0.012). More number of patients in the open group than the laparoscopy group underwent para-aortic lymphadenectomy (p<0.001). Conclusion: we have proved the benefits, disadvantages and the essential role of laparoscopy in treatment and surgical staging of EC. Laparoscopy is proved to be safe and effective technique with lower rates of blood loss and less rates of intra-and post-operative morbidity. Experienced surgeon could perform hysterectomy and lymphadenectomy with perfect cancer excision and staging as equally good to laparotomy.

Incidence of Ureteric injury in complicated cesarean section and late complications

Incidence of Ureteric injury in complicated cesarean section and late complications

Near-infrared fluorescence laparoscopy of the ureter with three preclinical dyes in a pig model

BackgroundUreteric injury is reported to occur in 1–7.6% of colorectal surgeries. To reduce the incidence of ureteral injury, it is essential to identify the ureters. The use of near-infrared fluorescence (NIRF) imaging with intravenously administered dyes might be of added value for ureteral visualization during laparoscopy. The aim of this study is to assess the performance of three preclinical dyes; IRDye® 800BK, IRDye® 800NOS and IRDye® 800CW, for near-infrared fluorescence laparoscopy of the ureter in pigs.MethodsIn three female Dutch landrace pigs, the new dyes were evaluated. In each pig, 1 dye was tested using a 6-mg intravenous dose in a concentration of 1 mg/ml. Imaging was performed in fluorescence mode and white light mode with a laparoscopic imaging system. In order to further evaluate the dyes, an ex vivo imaging experiment was performed, in which 8 decreasing concentrations per dye, diluted in PBS, were evaluated in a transparent test tube with NIRF mode at a distance of 1, 5 and 10 cm from the laparoscope.ResultsAll three dyes were effective in allowing the identification of the ureter with NIRF imaging. The ureter became fluorescent after 35, 45 and 10 min, respectively, for IRDye® 800BK, IRDye® 800NOS and IRDye® 800CW with a maximum target-to-background ratio (TBR) of 2.14, 0.66 and 1.44, respectively. In the ex vivo imaging experiment, all three dyes produced a strong fluorescence signal at all concentrations and all distances evaluated.ConclusionsIntravenous administration of the preclinical dyes IRDye® 800CW, IRDye® 800 BK and IRDye® 800NOS facilitated successful identification of the anatomical course of the ureter in living pig models. The highest measured TBR occurred with the use of IRDye® 800BK. Ex vivo, a correlation was observed between the fluorescence intensities of the signal with the concentration of the dye and with the distance to the object.

Prophylactic Ureteral Stenting in Laparoscopic Colectomy: Revisiting Traditional Practice

BackgroundProphylactic placement of ureteral stents is performed during open colectomy to aid in ureteral identification and to enhance detection of injury. The effects of this practice in laparoscopic colectomy are unknown. This study compares outcomes of patients undergoing laparoscopic colectomy with and without prophylactic ureteral stenting. MethodsA retrospective cohort study at a tertiary academic medical center was performed. The primary outcome measure was the incidence of ureteral injury. Secondary outcomes evaluated included mortality, length of stay, procedural duration, and new-onset urinary complication (hematuria, dysuria, and urinary tract infection). ResultsIn 702 consecutive patients undergoing elective laparoscopic colectomy from 2013 to 2016, prophylactic stents were placed in 261 (37%) patients. Two ureteral injuries occurred (0.3%), both in patients who underwent ureteral stent placement (P = 0.07) and were found and repaired intraoperatively. There was no in-hospital mortality. When accounting for age-adjusted Charlson comorbidity score, procedural indication, gender, BMI, and extent of resection, no difference in hospital length of stay (P = 0.79) was noted comparing patients with and without stenting. However, stent placement prolonged operating time (P = 0.03) and increased the risk of new-onset urinary complications (P = 0.04). ConclusionsIn this study, ureteral injuries only occurred in those with stent placement. Prophylactic ureteral stents in laparoscopic colectomy are associated with increased operative time and urologic morbidity. Owing to the low prevalence of ureteral injury in the elective setting and the increased risk of urinary complications, use of prophylactic ureteral stenting should be highly selective.

Diagnosis and Therapeutic Management in Kidney, Ureter and Bladder Trauma

Trauma refers to the destruction of tissues or organs by external forces and it is the most common cause of mortality and morbidity in children (1, 2). Injuries of the genitourinary tract may be the result of blunt (falls, sport injuries, motor vehicle accidents and sexual abuse) or penetrating (stab wounds, gun shots, falling onto sharp objects) injuries. The genitourinary tract is significantly injured in 2.9% of paediatric trauma patients 4.In the paediatric population, the kidney is the most affected organ in the genitourinary tract (>60% of all genitourinary tract injuries) 4. Blunt renal trauma is the most common type of injury representing 80-90% 4. The paediatric kidney is more susceptible due to less abdominal and retroperitoneal fat, weaker trunk and abdominal muscles and a lower position in the abdomen. Preexisting renal abnormalities such as UPJ obstruction, hydronephrosis, horseshoe kidney or ectopic kidney make the kidney more vulnerable. Spiral computed tomography is the gold standard method for radiological assessment. Surgical intervention is needed only in the minority of children. Isolated ureteral injury due to trauma is very rare in children. Penetrating ureteral trauma is more common than blunt trauma in the paediatric population. Among all urological trauma cases, the incidence of ureteral injury is lower than 1% [4]. Ureteral injuries include contusion, laceration and avulsion. Because of their hyperextensible vertebral column, children are more likely to sustain deceleration injuries. Delayed films of IVP and CT are the main diagnostic tools whereas the gold standard is retrograde ureteropyelography. Ureteral injury treatment options depend on the location of injury. The bladder in children is a more abdominal organ than in adults. Lying in an exposed position above the pelvis, the bladder is more vulnerable in this age group as it is less well protected due to the less developed abdominal fat and rectus muscles. Here, too, the most common type of trauma is blunt injury. High percentages of bladder injuries are associated with pelvic fractures (70-90%) 4. The average rate of bladder injury in patients with pelvic fractures is 4% in the paediatric age group 4. Conventional or CT cystography is the gold standard method of imaging.

Outcome of ureteral distensibility on the success of ureteroscopy: A prospective hospital-based descriptive study

Introduction“Difficult ureter” is a known problem that increases the complications during ureteroscopy. ObjectiveTo categorize ureters according to their distensibility, and to determine whether ureteric distensibility is associated with the success of ureteroscopy and its complications. Subjects and methodsBetween January 2010 and September 2012, we tested ureteral distensibility in 306 patients who had a unilateral single radiopaque ureteral stone, 6–20mm in diameter. Ureteral distensibility was classified into two categories according to the maximum size of a ureteral dilator that could be introduced before ureteroscopy: non-distensible ureters, which admitted a dilator up to 10 Fr and distensible ureters, which admitted a dilator >10 Fr. Correlations between distensibility and the success rate and complications of ureteroscopy were determined. ResultsOverall, 102 patients (33.3%) had non-distensible ureters and 204 (66.7%) had distensible ureters. Distensibility was correlated with the success of ureteroscopy because initial ureteroscopy failed in 38.2% of non-distensible ureters. Ureteroscopy was successful in all distensible ureters. The incidence of ureteric injury was higher in non-distensible ureters than in distensible ureters. ConclusionsOur results suggest that ureteric distensibility should be tested before ureteroscopy. Primary ureteroscopy is recommended in distensible ureters because of its low complication rates and favorable outcome. Pre-stenting may be necessary before ureteroscopy in non-distensible ureters; secondary ureteroscopy may be safer and more feasible in these settings.

Pattern of iatrogenic ureteral injuries in a tertiary health center in Nigeria

Objective: To assess etiology, nature of injuries, and reconstruction techniques employed in the management of iatrogenic ureteral injuries. Patients and Methods: A retrospective review of patients with iatrogenic ureteral injuries from January 2009 to December 2013 was done. Records of the patients were reviewed with respect to etiology, mode of presentation, nature of injury, and type of repair done. Results: Twenty patients with iatrogenic ureteral injuries underwent a total of 28 ureteral reconstruction procedures at our institution over the 5-year period. There were 19 female patients (95.5%) and only 1 male patient (4.5%). The mean age of the female patients was 34.5 ± 3.8 years. Of the iatrogenic injuries to the ureter, 50% occurred on the left side while 8 (28.6%) were bilateral. In majority of the cases, 26 (92.9%), these injuries were the result of inadvertent ligation of the ureter. The average time at presentation after the injuries was 29.1 weeks with a range of 2 days to 8 years. The most common gynecological operation implicated was total abdominal hysterectomy (TAH) (55%) followed by myomectomy (20%), ovariectomy (10%), cesarean section (10%), and excision of the right colonic tumor (5%). The commonest mode of presentation was leakage of urine from the vagina as seen in 10 (50.0%) patients while 25% had complete anuria. Ureteroneocystostomy (UNC) was performed in 19 (67.8%) ureters. Psoas hitch and Boari flap were done in four (14.3%) and three (10.7%) cases, respectively. One patient (3.6%) required a transureteroureterostomy (TUU) and another one (3.6%) required a right nephroureterectomy. Outcome of the treatment was judged as satisfactory in all the cases as defined by improvement or resolution of the symptoms and normalization of renal function. Conclusion: Abdominal hysterectomy still remains the dominant cause of iatrogenic injury to the ureter. UNC can often be used to establish ureteral continuity in most cases of iatrogenic injuries to the distal ureter. Injuries to the right ureter are more likely to involve the middle third of the ureter, requiring some form of bladder mobilization or bladder flap to establish ureteral continuity. Attention to preventive measures, especially during gynecological surgeries, will help to reduce the incidence of ureteric injuries.

The diagnosis and management of ureteric injury after laparoscopy

Abstract The number of ureteric injury cases has increased in gynecological surgery. We reviewed the literature concerning the incidence of ureteric injury and the recognition and management of the ureteric injury with the controversy of delayed management of ureteric injury. To reduce the morbidity of ureteric injury, gynecologists should be aware of and familiar with the pelvic wall anatomy, the site that is most susceptible to injury. They should also have knowledge about the prevention and management of ureteric injury.

Analysis of Ureteral Injuries for Laparoscopic Rectal Cancer Surgery

Ureteral injury is one of the major complications for rectal surgery. However, few studies focused on ureteral injuries from laparoscopic rectal surgery have been reported. Characteristics of this kind of ureteral injuries and the related reasons are unclear. This study was designed to illustrate the characteristics of ureteral injuries during the procedure of laparoscopic rectal surgery and to analyze the related reasons. Of 1120 patients with rectal cancer who underwent laparoscopic surgery between July 2007 and July 2013, 11 cases had the complication of ureteral injuries. Data of these 11 patients were collected and analyzed retrospectively. In our study, the total incidence of ureteral injuries from laparoscopic rectal surgery was 0.98%, and left ureteral injuries were more common. Five cases of ureteral injuries occurred at the takeoff of the inferior mesenteric artery, 4 cases occurred at the small pelvic inlet, and 2 cases occurred at the location where the infundibulopelvic ligament crosses the pelvic brim. Four reasons accounted for the ureteral injuries: 5 cases resulted from massive ligation or cutting off without recognizing the anatomical structure, 3 cases resulted from unfamiliarity with normal anatomical structure under laparoscopy and unskilled laparoscopic operation, 2 cases resulted from an abnormal anatomical structure due to invasion of the tumor, and 1 case resulted from an unusual anatomical variation of ureter. It was easier to damage the left ureter during the procedure of laparoscopic rectal surgery. In conclusion, ureteral injuries usually occurred at three locations, and massive ligation or cutting off without recognizing the anatomical structure was the most common reason for laparoscopy-related ureteral injuries.

Ureteral injury after laparoscopic versus open colectomy.

Background and Objectives:Ureteral injury is an infrequent but potentially lethal complication of colectomy. We aimed to determine the incidence of intraoperative ureteral injury after laparoscopic and open colectomy and to determine the independent morbidity and mortality rates associated with ureteral injury.Methods:We analyzed data from the National Surgical Quality Improvement Program for the years 2005–2010. All patients undergoing colectomy for benign, neoplastic, or inflammatory conditions were selected. Patients undergoing laparoscopic colectomy versus open colectomy were matched on disease severity and clinical and demographic characteristics. Multivariate logistic regression analyses and coarsened exact matching were used to determine the independent difference in the incidence of ureteral injury between the 2 groups. Multivariate models were also used to determine the independent association between postoperative complications associated with ureteral injury.Results:Of a total of 94 526 colectomies, 33 092 (35%) were completed laparoscopically. Ureteral injury occurred in a total of 585 patients (0.6%). The crude incidence in the open group was higher than that in the laparoscopic group (0.66% versus 0.53%, P = .016). CEM produced 14 630 matching pairs. Matched analysis showed the likelihood of ureteral injury after laparoscopic colectomy to be 30% less than after open colectomy (odds ratio, 0.70; 95% confidence interval, 0.51–0.96). Patients with ureteral injury were independently more likely to have septic complications and have longer lengths of hospital stay than those without ureteral injury.Conclusion:Laparoscopic colectomy is associated with a lower incidence of intraoperative ureteral injury when compared with open procedures. Ureteral injury leads to significant postoperative morbidity even if identified and repaired during the colectomy.

Early surgical intervention versus medical expulsive therapy for renal colic

derwent retrograde intra-renal surgery (RIRs) using ureteral access sheath from March 2010 to october 2010 in two different centrers. There were 92 men and 44 women with mean age was 51.6 years (ranged from 14 to 84). All UAS were 12 14 Fr. Group of patients (39.7 %) were pre-stented. At the end of procedure, ureteric injuries were evaluated clinically through endoscopic exploration. Therefore, we presented our classification of ureteric endoscopic injuries based on the anatomy of ureteric wall. When different types of injuries coexist, the higher grade was documented. Factors that affect clinical outcomes were evaluated statistically. RESULTS: From our data, 68 patients (50%) had no ureteric injury at the end of procedure. On the other hand, 68 patients had at least one iatrogenic injury of the ureteric wall. We reported, 47 patients with ureteral injury grade 1 (35%), 15 with grade 2 (11%) and 6 with ureteric perforation (4%). Patients characteristics such as age, gender, body mass index and history of previous ureteroscopy were not statistically significant. Nevertheless, the incidence of ureteric injuries was significantly lower in pre-stenting patients (p 0.0001). Moreover, operative time was correlated to the icidence of ureteraic injuries (p 0.031). CONCLUSIONS: Insertion of ureteral access sheath during RIRS procedure may induce severe ureteric injuries. Ureteral prestenting reduces significantly the incidence of this complication.