Management of early ureteral injury complications

Abstract

Introduction. Ureteral traumas account for approximately 3% of all urinary tract injuries. Up to 38 – 80 % of ureteral injuries are misdiagnosed. Consequently, missed ureteral injuries lead to the development of complications.Objective. To determine the comprehensive management for early complications of ureteral injuries.Materials & methods. From 2000 to 2022, 46 patients with early complications of various mechanisms, types, and severity of ureteral injuries were treated at the Dzhanelidze Research Institute of Emergency Medicine. The severity of ureteral injury complications was determined using the Clavien-Dindo classification system. Reconstructive and staged operations were performed in the treatment of ureteral injury complications.Results. Fourty-three patients (93.5%) had iatrogenic injuries, 2 (33.3%) had blunt traumas, and 1 (2.2%) had an open injury. Ureteral injuries included rupture, ligation, endoclips compression, and thermal injury. The type of ureteral trauma determined the development of early complications. Ureteral ligation and endoclips compression led to the development of acute renal colic, hydronephrosis, and obstructive pyelonephritis. Ureteral rupture and thermal injury were complicated by urinary leaks and peritonitis. According to the Clavien-Dindo classification, the complications were IIIb and IV grade. Staged procedures were performed for the treatment of ureteral injuries complications in the presence of infection. In other cases, reconstructive operations were performed on hemodynamically stable patients with ureteral injury complications.Conclusion. The choice of management for early complications of ureteral injuries depends on the patient's condition, the presence of infection, the mechanism, type, and localisation of the ureteral trauma.

Keywords

• ureteral injury
• complications
• treatment
• reconstructive surgery
• staged procedures
• ureteral repair