Endoscopic realignment in the management of complete transected ureter

Purpose

To present experience and feasibility of endoscopic realignment for treatment of delayed recognized iatrogenic complete transected ureteral injuries.

Patients and methods

Patients suffering from iatrogenic complete transected ureteral injuries were treated by two surgeons. Five women and 3 men with a mean age of 50.8 years (range 22–69) received diagnosis during the immediate postoperative period (2–6 days after surgery). Ureteral continuity was re-established using a technique combining antegrade flexible ureteroscopy and retrograde rigid ureteroscopy. Then, three ipsilateral 5F double J stents were inserted to assure ureteral patency.

Results

All eight realignment procedures were successful, and no major complications occurred. Average injury length was 1.9 cm (range 1.5–3.0). Average hospitalization time was 8 days (range 3–14). Nephrostomy tubes and stents were removed after a mean period of 3.9 weeks (range 2–6) and 6.8 months (range 5.9–7.1), respectively. At a mean follow-up of 21.5 months (range 10–56), 6 patients were stent-free without image evidence of obstruction, a patient developed strictures was treated with balloon dilation and another exchanged double J stents periodically. No patient has developed significant renal impairment.

Conclusion

Endoscopic realignment is a safe and efficient method as an initial procedure to manage iatrogenic complete transected ureteral injuries in properly selected cases.