Tips for Managing Acute Iatrogenic Ureteric Injury




© Springer-Verlag London 2017
Abhay Rané, Burak Turna, Riccardo Autorino and Jens J. Rassweiler (eds.)Practical Tips in Urology10.1007/978-1-4471-4348-2_6


6. Tips for Managing Acute Iatrogenic Ureteric Injury



Celi Varol1   and A. S. Goolam1


(1)
Department of Urology, Macquarie University Hospital, Australian School of Advanced Medicine, Sydney, NSW, Australia

 



 

Celi Varol

Email:


Abstract

Traditionally, ureteric injuries during minimally invasive procedures have meant that conversion to an open operation was required. With the popularity of the Da Vinci robot, vision and access within the pelvis has improved and suturing in particular has become much easier when compared to laparoscopy. This has facilitated the completion of repair of injuries in a minimally invasive manner on a more regular basis. High index of suspicion and early definitive repair assist in reducing morbidity and further associated complications.


Keywords
Iatrogenic ureteric injuryManagement



Introduction


Iatrogenic injury of the ureter is best repaired at the time of injury and thus requires a high index of suspicion intra-operatively [1, 2, 6]. Failure to recognize an intra-operative ureteric injury may lead to preventable sequelae and morbidity (typically as a result of an open procedure required for delayed repairs) [4]. Ureteric injury can be encountered during endoscopic, laparoscopic, robotic and open procedures. All repairs, if possible should be attempted in the same surgical approach the injury occurred. The least to most reconstructive surgical repair that is necessary, without compromising the success of outcome should be the aim. It is important to protect the renal unit and allow adequate urine drainage

When approaching an iatrogenic ureteric injury, several pertinent factors need to be taken into account. The best type of repair and approach can be determined via the following salient points:


  1. 1.


    Mechanism of the injury (avulsion, transection, ligation, laceration, crush or thermal)

     

  2. 2.


    Location of the injury (lower, mid or upper ureter)

     

  3. 3.


    Resection of ureter – where ureteric length has been lost

     


Basic Principles


Irrespective of surgical repair approach that is intended, the basic principles must be applied at all times when repairing an iatrogenic ureteric injury [1, 3]. All anastomotic repairs must adhere to the following:



  • Vascularized healthy tissue


  • Spatulated, tension free and watertight anastomosis


  • Absorbable suture material – (4-0 or 5-0)


  • Stented internally


  • Drained externally


  • Bladder must be catheterized


  • Omental or vascularized tissue wrap (if deemed necessary)

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Nov 21, 2017 | Posted by in UROLOGY | Comments Off on Tips for Managing Acute Iatrogenic Ureteric Injury

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