Possible Complications of Ureteroscopy in Modern Endourological Era: Two-Point or “Scabbard” Avulsion (original) (raw)
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Urology journal, 2012
PURPOSE To evaluate the prevalence and type of rigid ureteroscopy complications and suggest a new method for ureteral avulsion prevention. MATERIALS AND METHODS Between March 2002 and March 2009, we retrospectively evaluated 2955 patients who had undergone diagnostic or therapeutic ureteroscopy for asymptomatic hematuria, migrated ureteral stent, or transurethral lithotripsy. They were enrolled from four hospitals in Ahvaz, Iran. RESULTS Complications were encountered in 241 (8%) patients, including transient hematuria (4.2%), mucosal erosion (1.4%), stone migration (1.3%), ureteral perforation (1.2%), and fever and/or sepsis (1.0%). Ureteral avulsion occurred in 6 (0.2%) patients. Mostly, complications were managed conservatively, using ureteral stenting. Ureteral avulsions were managed using a new technique. CONCLUSION In our series, the complication rate is comparable with the literature. A new technique was used in case of ureteroscope entrapment in the ureter, to lessen the occ...
Management of ureteric avulsion during ureteroscopy: a systematic review and our experience
African Journal of Urology
Background Ureteric avulsion is a disastrous intraoperative complication that can happen to any urologist during a common endoscopic procedure like ureteroscopy. The aim of this study is to evaluate the various management options of ureteric avulsion during ureteroscopy and also report our relevant experience in this topic. Results The Preferred Reporting Items for Systematic Reviews and Meta-Analyses of existing literature in English language was used in the period 1967–2019 with a literature search in PubMed, Cochrane Library and Google Scholar. Forty-three patients in twenty-three articles who had undergone management of ureteric avulsion during ureteroscopy were identified for review. There were 15 proximal, 19 two-point (“scabbard”) and 9 distal avulsions. All distal avulsions were managed successfully with ureteroneocystostomies or Boari flaps. Boari flaps and ureteropyelostomy with ureterovesicostomy were the common procedures used for proximal avulsions. Proximal avulsions h...
The management of total avulsion of the ureter from both ends: Our experience and literature review
Archivio Italiano di Urologia e Andrologia, 2016
Objective: To evaluate the treatment modalities of total ureteral avulsion and to clarify the risk factors of this serious complication. Methods: This study retrospectively analyzed the data of 3 patients with complete ureteral avulsion during ureteroscopy. Of the three patients, two had distal ureteral complete avulsion, and one total ureteral avulsion on both ends. Ureteroneocystostomy (UNC) was immediately performed after distal ureteral avulsion cases. Ileal ureter substition was performed on the same session after the total ureteral avulsion in both ends. Two of the patients were under chronic use of corticosteroid treatment due to diagnosis of idiopathic trombocytopenic purpura and myastenia gravis and all patients had unsuccesful shockwave litotripsy (SWL) treatment history with at least 1 month period before surgery. Results: The patient who had ileal ureter substitution was followed at 3-month intervals by ultrasonography and renal function tests and she was uneventful afte...
Avulsion of ureter by blunt trauma
Urology, 1979
Six cases of amdsion of the upper ureter by blunt trauma are presented: 5 in children and one in an adult. One of these also inoolned the entire renal pedicle. A review of the literature shows that this type of trauma is rare, about 30 cases having been reported. They are seen mostly in children, and the right kidney is more prone to injury. Often, there is absence of hematuria which leads to considerable delay in diagnosis and surgical repair. On account of this delay, hydronephrosis, infection, and sometimes pseudocyst formation can complicate the initial pathologic condition. Despite these delays, successful repair can be accomplished and the kidney salcaged. In some instances, as we found out in our cases, a retrograde pyelogram was helpful in establishing the diagnosis and localizing the site of the lesion preoperatirely.
International Urology and Nephrology, 2005
Objective: To investigate the changing pattern in incidence, aetiological factors and the effect of early diagnosis and surgical treatment on the outcome of iatrogenic ureteric injuries in our Urology Unit over a 5 year period. Patients/Methods: All patients with ureteric injuries caused as a result of any surgical procedures (iatrogenic ureteric injuries) were studied during a 5 year period (1998)(1999)(2000)(2001)(2002). Data collected and analysed included yearly incidence of injury, aetiological factors, modalities of treatment and the outcome of management of the injuries. During the study period, our general surgical colleagues had a policy of requesting ''J'' stent insertion prior to major abdominopelvic surgical procedures. During the same period, in nearly all difficult cases of ureteroscopy (URS) + lithoclast lithotripsy±Dormia basket, a ureteric catheter or ''J'' stent was prophylactically inserted by urological surgeons. Results: There were 82 iatrogenic ureteric injuries in 75 patients over the 5 year period. The total number of iatrogenic ureteric injuries declined from 26 (31.7%) in 1998 to 10 (11.8%) in 2002. Urological, obstetrics and gynaecological and general surgical procedures were involved in 69(84.1%), 7(8.7%), and 4(4.9%) of the injuries respectively. The commonest types of injuries encountered were; injury to ureteric mucosa post URS or lithoclast calculi disintegration 34 (41.5%), complete ureteric perforation 15 (18.3%) and false passage 15 (18.3%). The most severe complications encountered were complete ureteric avulsions 3 (3.75%) and loss of ureteral segment 2 (2.4%). The commonest treatment options used were ''J'' stent insertion or ureteric catheter placement (48, 59.4%), percutaneous nephrostomy (17, 20.7%), laparotomy and removal of suture on tied ureters (5, 6.1%). Two (2.4%) nephrectomies were performed because of poor renal function in one patient and severe damage to a functioning renal unit during a difficult retroperitoneal surgery in another patient. Recognition and treatment of ureteric injuries at the time of surgery was associated with less morbidity compared to those in whom the diagnosis was delayed. The overall successful resolution of ureteric injuries in this series was 77/82 (93.9%). There was no mortality attributable to these ureteric injuries. Conclusion: In our Unit, the incidence of significant iatrogenic ureteric injuries has shown a decline over a 5-year period. We attribute this trend to the prophylactic use of ''J'' stents or ureteric catheter placement and good surgical technique during major abdomino-pelvic surgeries in our hospital. Endourological procedures are the commonest causes of ureteric injuries. Prompt diagnosis and institution of appropriate corrective surgical procedures often result in a very satisfactory outcome in about 94% of cases.
Complications of Ureteroscopic Approaches, Including Incisions
Current Clinical Urology, 2006
Ureteroscopy has progressed from cystoscopic examination of a dilated ureter in a child in 1929 and the initial use of rigid ureteroscopes in the 1980s, to its current state of small caliber semirigid and flexible instruments. In this chapter the authors review complications of ureteroscopy including those associated with incisional techniques where one would anticipate a higher incidence of complications. They review the history and development of modern ureteroscopes, focusing on engineering advances. Clinical points made include proper patient selection and preparation; proper use of dilators, wires, and ureteral access sheaths; and the incidence, identification, and management of complications associated with ureterorenoscopy (both intraopertively and postoperatively).
Management of ureteral avulsion as a complication of ureterorenoscopy
turkurolojidergisi.com
Üreterorenoskopi'nin bir komplikasyonu olan üreter kopmasına yaklaşım ... Fikret Fatih Önol1, Yılören Tanıdır2, Alpaslan Akbaş3, Emin Özbek3, Şinasi Yavuz Önol3 ... 1Ministry of Health Sakarya Training and Research Hospital, Clinic of Urology, Sakarya 2Ministry of ...
A review of ureteral injuries after external trauma
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2010
Introduction Ureteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this article is to review the literature since 1961 with the primary objective to present the largest medical literature review, to date, regarding ureteral trauma. Several anatomic and physiologic considerations are paramount regarding ureteral injuries management. Literature review Eighty-one articles pertaining to traumatic ureteral injuries were reviewed. Data from these studies were compiled and analyzed. The majority of the study population was young males. The proximal ureter was the most frequently injured portion. Associated injuries were present in 90.4% of patients. Admission urinalysis demonstrated hematuria in only 44.4% patients. Intravenous ureterogram (IVU) failed to diagnose ureteral injuries either upon admission or in the operating room in 42.8% of cases. Ureteroureterostomy, with or without indwelling stent, was the surgical procedure of choice for both trauma surgeons and urologists (59%). Complications occurred in 36.2% of cases. The mortality rate was 17%. Conclusion The mechanism for ureteral injuries in adults is more commonly penetrating than blunt. The upper third of the ureter is more often injured than the middle and lower thirds. Associated injuries are frequently present. CT scan and retrograde pyelography accurately identify ureteral injuries when performed together. Ureteroureterostomy, with or without indwelling stent, is the surgical procedure of choice of both trauma surgeons and urologists alike. Delay in diagnosis is correlated with a poor prognosis.
A Case of Iatrogenic Ureter Injury: Recent Diagnostic and Treatment Methods
Journal of Urological Surgery, 2016
The ureters are rarely exposed to trauma. Ureteral injuries are generally in the form of iatrogenic, blunt injuries, and rarely penetrating injuries. Iatrogenic injuries often occur during surgical procedures. They do not present with specific findings and symptoms, therefore, they have lateonset symptoms. Imaging modalities of choice are usually intravenous pyelography and computed tomography. Treatment is tailored to the location of the trauma.
Immediate and late management of iatrogenic ureteric injuries: 28years of experience
Arab Journal of Urology, 2015
Objective: To evaluate the long-term results after managing intraoperative and late-diagnosed cases of iatrogenic ureteric injury (IUI), treated endoscopically or by open surgery. Patients and methods: Patients immediately diagnosed with IUI were managed under the same anaesthetic, while those referred late had a radiological assessment of the site of injury, and endoscopic management. Open surgical procedures were used only for the failed cases with previous diversion. Results: In all, 98 patients who were followed had IUI after gynaecological, abdominopelvic and ureteroscopic procedures in 60.2%, 14.3% and 25.5%, respectively. The 27 patients diagnosed during surgery were managed immediately, while in the late-referred 71 patients ureteroscopic ureteric realignment with stenting was successful in 26 (36.6%). Complex open reconstruction with re-implantation or ureteric substitution, using bladder-tube or intestinal-loop procedures, was used in 27 (60%), 16 (35.5%) and two (4.5%) patients of the late group, respectively. A long-term radiological follow-up with a mean (range) of 46.6 (24.5-144) months showed recurrent obstruction in 16 (16.3%) patients managed endoscopically and reflux in six (8.3%) patients. Three renal units only (3%) were lost in the late-presenting patients. Conclusion: Patients managed immediately had better long-term results. More than a third of the late-diagnosed patients were successfully managed endoscopically