[Application of ureteral realignment under the guidance of ureteroscope in iatrogenic ureteral injuries].

OBJECTIVE

To determine the value of ureteral realignment under ureteroscope in the treatment of iatrogenic ureteral injury.

METHODS

In the study, 14 cases of ureteral injury were caused by gynecological laparoscopic surgery, with mean age being 46 (24 to 71) years. Including 1 bilateral injury, 10 right ureteral lesions and 3 left ureteral lesions, 9 of the 15 ureteral lesiors had both ureteral fistula and obstruction, and 6 had complete ureteral obstruction. The diagnosis was delayed with a median time of 20 (0 to 207) days. Uronephrosis ranged from 2.5 to 4.2 cm, and creatinine level of drainage or vaginal discharge was 2 439 (655 to 6 317) μmol/L. Complete ureteral obstruction and urinary fistula were seen under a combined retrograde and antegrade study. A guidewire could not pass across the injured area of the ureter. Guidewire was indwelled in the proximal end ureter by nephrostomy, ureter incision was preformed with the ureteroscope under the guidance of fluoroscopy, realignment of proximal and distal end of ureteral lesion was made at once, and stents were indwelled. Altogether, 15 operations were performed. B-us, KUB, IVP and long term follow up were carried out after the operation.

RESULTS

Ureteral realignments were successful in 14 patients, all stents were in position, and retention time of the stents was 12 months. Follow up time lasted from 185 to 964 days. No recurrence hydronephrosis was ever seen after the operation.

CONCLUSION

Awareness of ureter protection should be enhanced within laparoscopic surgery; Ureteral realignment under ureteroscope can remedy iatrogenic ureteral injuries by simple and minimum invasive operation, and it can also avoid the open operation.