Treatment of iatrogenic ureteral injuries during various operations for malignant conditions.

In the present study we report twenty-nine patients with iatrogenic injuries and management during various operations for malignant conditions. The patients were reviewed in order to identify and study the incidence, type of treatment administered and outcome. The study group was composed of 29 patients with 31 iatrogenic injuries between 1992 and 1999. General surgical, gynecological and urological procedures accounted for 24 (83%), 4 (14%), and 1 (3%) injuries respectively. Twenty-eight injuries were diagnosed at operation and three after an interval of 5, 17 and 45 days. Of the injuries, 51% occurred in the lower third of the ureter, 30% in the upper third and 19% in the middle third. Complete transsection, excision, ligation and partial transection accounted for 19 (61%), 9 (29%), 2 (7%), and 1 (3%) respectively. Treatment consisted of end-to-end ureteroureteral anastomosis in 18 cases; ileal interposition in 4 cases; transureteroureterostomy and ureteroneocystostomy in 2 cases; surgical repair, nephrectomy, ureterocutaneostomy and ileal loop in each of the remaining cases. Primary healing was obtained in all patients. General surgical procedures are the most common cause of iatrogenic injuries during malignant conditions. The proper identification and, when necessary, identification of the ureter at the pelvic brim, should decrease the incidence of iatrogenic ureteral injury. When identified at injury and treated immediately such injuries seldom lead to loss of renal function. We do not advocate to perform nephrectomy for any type of ureteric injury since the preservation of the kidney should be the aim of a surgeon.