Iatrogenic Ureteral Injury
Review literature: (Elliott and McAninch, 2006) (Preston, 2000).
Epidemiology of Iatrogenic Ureteral Injuries
The following urological operations jeopardize the ureter: ureteroscopy, retropubic prostatectomy, simple prostatectomy, transurethral resection of the prostate or bladder, pelvic or retroperitoneal lymphadenectomy. Frequent operations of other departments with risk for the ureter are hysterectomy, colon surgery and vascular surgery.
Etiology
Dissection, suture, ligature, contusion, infection, hematoma, lymphocele.
Signs and symptoms
Flank pain, abdominal pain, fever, upper urinary tract obstruction, hematuria, urinoma, ascites, peritonitis, or urine secretion via the wound or vagina.
Diagnostic Work-Up
- Abdominal and renal sonography
- Intravenous urography, or better an abdominal computed tomography
- Cystoscopy and retrograde pyelography, if endoscopic treatment is deamed possible
Treatment of Iatrogenic Ureter Injury
Endoscopic Treatment
Endoscopic treatment is an option, if antegrade or retrograde placement of a ureteral stent is possible. Depending on the healing of the ureter, the ureteral stent can be withdrawn. In persisting ureteral stricture, surgical treatment is necessary.
Surgical Treatment
Indications for surgical treatment are frustrane endoscopic treatment results, urinous ascites, ureteral-vaginal fistula, and persistent ureteral stricture after endoscopic treatment. For details of the surgical procedures (e.g. ureteroureterostomy), please see section ureteral stricture.
| Ureteral Trauma | Index | Ureter diseases |
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References
- Elliott und McAninch 2003 ELLIOTT, S. P. ; MCANINCH, J. W.:
- Ureteral injuries from external violence: the 25-year experience at
San Francisco General Hospital.
In: J Urol
170 (2003), Nr. 4 Pt 1, S. 1213–6
- Elliott, S. P. & McAninch, J. W.
- Ureteral
injuries: external and iatrogenic
Urol Clin North Am, 2006, 33, 55-66, vi - Preston PRESTON, J. M.:
- Iatrogenic ureteric injury: common medicolegal pitfalls.
In: BJU Int
86 (2000), Nr. 3, S. 313–7
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Deutsche Version: Traumatische und iatrogene Verletzung des Harnleiters
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man...@urologielehrbuch.de