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    Korean J Urol. 2007 Oct;48(10):1035-1039. Korean.
    Published online Oct 31, 2007.
    https://doi.org/10.4111/kju.2007.48.10.1035
    Copyright © 2007 The Korean Urological Association
    Original Article

    Severe Iatrogenic Ureteral Avulsions Caused by the Ureteroscopic Procedures

    Eun Ju Seo, Taek Won Kang,1 and Jun Hwa Noh
      • Department of Urology, Kwangju Christian Hospital, Gwangju, Korea.
      • 1Department of Urology, Chonnam University Medical School, Gwangju, Korea.
    • Corresponding author (Email: urojh@mdhouse.com )
    Received May 18, 2007; Accepted August 20, 2007.

    Abstract

    Purpose

    We reviewed the incidence, causes, location, treatment and prognosis of the severe iatrogenic ureteral avulsions caused by ureteroscopy procedures.

    Materials and Methods

    We analyzed the records of eight patients with ureteral avulsion out of 683 patients treated with ureteroscopic procedures, retrospectively. The patients had surgical correction or ureteral double-J stenting for the iatrogenic ureteral avulsions.

    Results

    The incidence of ureteral avulsion was 1.17%. While seven cases occurred during ureteroscopic removal of a stone, five cases among them occurred during stone basketing and two cases occurred during insertion of the ureteroscope. Another case among eight avulsion cases occurred while removing the during an endopyelotomy for a ureteral stricture. Depending on the length of the ureteral avulsion, four cases were over 2cm, the patientsopen surgical repair for ureteral continuity restoration immediately; three cases, under 2cm, were treated with indwelling ureteral double J stents, and one case with an injury to the entire ureter was treated with a nephrectomy. The result of the surgical treatment as the initial treatment was good in all cases. On the other hand, among the three cases with an inserted ureteral double-J stent, one case had aresult and the other two developed hydronephrosis.

    Conclusion

    Careful attention to surgical techniques and awareness of risk factors and types of potential injuries are essential to reduce severe iatrogenic ureteral avulsions. Our reports suggest that open surgical repair is better than an indwelling ureteral double-J stent for patients with a ureteral avulsion.

    Keywords
    Iatrogenic; Ureter; Avulsion; Ureteroscopy

    Tables

    Table 1
    Characteristics of patients and surgical procedures

    Table 2
    Characteristics of the ureteral avulsion

    Table 3
    Management and follow-up of the ureteral avulsion

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    MeSH Terms
    Constriction, Pathologic
    Hand
    Humans
    Hydronephrosis
    Incidence
    Nephrectomy
    Prognosis
    Retrospective Studies
    Risk Factors
    Stents
    Ureter*
    Ureteroscopes
    Ureteroscopy
    Metrics
    Share
    Tables
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