Abstract
Objectives
To evaluate the treatment alternatives of total avulsion of the ureter from both ends including ureteropelvic junction (UPJ) and ureterovesical junction (UVJ).
Methods
Total ureteral avulsion on both ends of the ureter was examined in 4 cases performing ureteroscopy. In two male patients of the four cases, avulsion was noticed intraoperatively and ureteral re-anastomosis at UPJ and re-implantation at UVJ were performed immediately. Boari flap was performed for one female patient immediately and for the other female patient who was referred from another hospital after the ureteroscopy, 4 days later.
Results
One patient who had ureteral re-implantation was followed with 3-month intervals by ultrasonography and abdominal X-ray. At the end of 1 year, it was determined that kidney parenchyma was normal and the patient had kidney and upper ureteral stones. Percutaneous nephrolithotomy was performed, and the patient was stone-free at the end of the operation. Two years after the surgery, both kidneys were normal. This is the only case who had a successful ureteral re-implantation in literature. The other patient turned up a year later for routine checks after the ureteral stent was removed. Then, hydronephrosis and renal atrophy were detected. The patient did not accept nephrectomy or any other intervention and he was lost to follow-up. Boari flap procedure was performed after UPJ repair for the other two female patients. Their kidneys were both normal 3 months after the operation.
Conclusions
In case of ureteral avulsion from both ends of the ureter in the male patients, as bladder capacity is not enough for a Boari flap, proximal anastomosis and distal re-implantation could be a good choice for the management of this untoward event. This new approach also saves time for reconstructive treatments if necessary. If bladder capacity is enough to reach UPJ, Boari flap could be a good choice in female patients.
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References
Al-Awadi K, Kehinde EO, Al-Hunayan A, Al-Khayat A (2005) Iatrogenic ureteric injuries: incidence, aetiological factors and the effect of early management on subsequent outcome. Int Urol Nephrol 37:235–241
Butler MR, Power RE, Thornhill JA, Ahmad I, McLornan I, McDermott T, Grainger R (2004) An audit of 2273 ureteroscopies—a focus on intra-operative complications to justify proactive management of ureteric calculi. Surgeon 2(1):42–46
Fuganti PE, Pires S, Branco R, Porto J (2008) Predictive factors for intraoperative complications in semirigid ureteroscopy: analysis of 1235 ballistic ureterolithotripsies. Urology 72(4):770–774
D’Addessi A, Bassi P (2011) Ureterorenoscopy: avoiding and managing the complications. Urol Int 87:251–259
de la Rosette JJ, Skrekas T, Segura JW (2006) Handling and prevention of complications in stone basketing. Eur Urol 50(5):991–998
Martin X, Ndoye A, Konan PG, Feitosa Tajra LC, Gelet A, Dawahra M, Dubernard JM (1998) Hazards of lumbar ureteroscopy: apropos of 4 cases of avulsion of the ureter. Prog Urol 8(3):358–362
Alapont JM, Broseta E, Oliver F, Pontones JL, Boronat F, Jiménez-Cruz JF (2003) Ureteral avulsion as a complication of ureteroscopy. Int Braz J Urol 29(1):18–22
Gupta V, Sadasukhi TC, Sharma KK, Yadav RG, Mathur R, Tomar V, Yadav SS, Priyadarshi S, Gupta P (2005) Complete ureteral avulsion. ScientificWorldJournal 28(5):125–127
Trinchieri A, Montanari E, Salvini P, Berardinelli L, Pisani E (2001) Renal autotransplantation for complete ureteral avulsion following lumbar disk surgery. J Urol 165(4):1210–1211
Ordon M, Schuler TD, Honey RJ (2011) Ureteral avulsion during contemporary ureteroscopic stone management: “the scabbard avulsion”. J Endourol 25(8):1259–1262
Lloyd SN, Kennedy C (1989) Autotransplantation of the vermiform appendix following ureteroscopic damage to the right ureter. Br J Urol 63(2):216–217
Juma S, Nickel JC (1990) Appendix interposition of the ureter. J Urol 144(1):130–131
Dagash H, Sen S, Chacko J, Karl S, Ghosh D, Parag P, Mackinnon AE (2008) The appendix as ureteral substitute: a report of 10 cases. J Pediatr Urol 4(1):14–19
Ge C, Li Q, Wang L, Jin F, Li Y, Wan J, Lan W, Liang P (2011) Management of complete ureteral avulsion and literature review: a report on four cases. J Endourol 25(2):323–326
Taie K, Jasemi M, Khazaeli D, Fatholahi A (2012) Prevalence and management of complications of ureteroscopy: a seven-year experience with introduction of a new maneuver to prevent ureteral avulsion. Urol J 9(1):356–360
Pinto AC, Macea JR, Pecoraro MT (2012) Femoral nerve neuropathy after the psoas hitch procedure. Einstein 10(3):371–373
Mauck RJ, Hudak SJ, Terlecki RP, Morey AF (2011) Central role of Boari bladder flap and downward nephropexy in upper ureteral reconstruction. J Urol 186(4):1345–1349. doi:10.1016/j.juro.2011.05.086
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Unsal, A., Oguz, U., Tuncel, A. et al. How to manage total avulsion of the ureter from both ends: our experience and literature review. Int Urol Nephrol 45, 1553–1560 (2013). https://doi.org/10.1007/s11255-013-0505-0
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DOI: https://doi.org/10.1007/s11255-013-0505-0