Management of Ureteric Injuries
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Abboudi, H., et al. (2013). "Ureteric injury: a challenging condition to diagnose and manage." Nature Reviews Urology 10(2): 108-115 https://doi.org/10.1038/nrurol.2012.254 PDF AT LINK
In this Review article, Abboudi et al. provide an overview of the incidence, diagnosis, and management of ureteric injuries, particularly regarding the benefits of minimally invasive surgery compared with open techniques.
Ade-Ojo, I. P. and O. and Tijani (2021). "A Review on the Etiology, Prevention, and Management of Ureteral Injuries During Obstetric and Gynecologic Surgeries." International Journal of Women's Health 13(null): 895-902 https://www.tandfonline.com/doi/abs/10.2147/IJWH.S330060 PDF AT LINK
Iatrogenic ureteral injuries are a rare but serious complication of some gynecological and obstetric procedures with both high morbidity and legal implications. The incidence varies widely depending on the type and extent of the surgeries with about 70% unrecognized intraoperatively. When recognized intraoperatively and promptly managed, the prognosis is good. Ureteral injuries recognized postoperatively come with dire consequences for the patients and are litigation prone. Due to the proximity of the lower half of the ureters to the pelvic organs, 50% of the cases of injuries to the ureter occur within the jurisdiction of gynecological and obstetric practice. A good knowledge of the etiology, predisposing factors, appropriate surgical skills, proper identification of the course and deviation of the ureters, and intraoperative recognition of inadvertent damage to the ureter and its vasculature is required by all obstetricians and gynecologists to reduce the incidence of ureteral injuries by at least 50%. This review aims to add to what is already known, particularly among obstetricians and gynecologists practicing in resource-constrained settings.
Li, X., et al. (2022). "Etiology, characteristics and management of ureteric injury: experience from a nationwide study." Transl Androl Urol 11(6): 794-802
https://pmc.ncbi.nlm.nih.gov/articles/PMC9262749/ PDF AT LINK
BACKGROUND: To investigate the common etiologies, characteristics, and management of ureteric injury. METHODS: A nationwide study was performed in 38 medical centers from Mar 2017 to Mar 2019. The data of patients with ureteric injury were retrospectively collected. RESULTS: Overall, 294 patients were included in this study. Ten cases (3.4%) were due to abdominal injuries, and 284 cases (96.6%) were due to iatrogenic injuries, including 48.6% from urological procedures, 41.9% from gynecological procedures, 6.3% from general surgery, and 3.2% from other treatments. Most urological injuries (79.7%) were caused by endourological procedures. Injury occurred in the distal ureter in 178 cases (60.5%), the mid-ureter in 31 cases (10.5%), and the proximal ureter in 85 cases (28.9%). Only 51 patients (17.3%) were diagnosed immediately during primary surgery. Immediate ureter reconstruction was performed in 30 patients (58.8%), while delayed urinary diversion was performed in 148 patients (60.9%) in the delayed diagnosis group. The side and the location of the injury were different between the urological and nonurological injury groups (P<0.001). Ureteric injuries were diagnosed timelier in the urological group than in the nonurological group (P=0.037). CONCLUSIONS: Iatrogenic injury was the most common cause of ureteric injury. The majority of iatrogenic injuries were caused by urological procedures and were primarily due to aggressive endourological techniques. Depending on the condition of the patient, the time of diagnosis, and the location and length of the ureteric injury, different management strategies should be applied.
Patel, A. B., et al. (2023). "Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians." Journal of Clinical Medicine 12(4): 1495 https://www.mdpi.com/2077-0383/12/4/1495 PDF AT LINK
Abstract
Iatrogenic ureteral injuries are a rare but serious complication of some gynecological and obstetric procedures with both high morbidity and legal implications. The incidence varies widely depending on the type and extent of the surgeries with about 70% unrecognized intraoperatively. When recognized intraoperatively and promptly managed, the prognosis is good. Ureteral injuries recognized postoperatively come with dire consequences for the patients and are litigation prone. Due to the proximity of the lower half of the ureters to the pelvic organs, 50% of the cases of injuries to the ureter occur within the jurisdiction of gynecological and obstetric practice. A good knowledge of the etiology, predisposing factors, appropriate surgical skills, proper identification of the course and deviation of the ureters, and intraoperative recognition of inadvertent damage to the ureter and its vasculature is required by all obstetricians and gynecologists to reduce the incidence of ureteral injuries by at least 50%. This review aims to add to what is already known, particularly among obstetricians and gynecologists practicing in resource-constrained settings.
Sahai, A., et al. (2021). "British Association of Urological Surgeons (BAUS) consensus document: management of bladder and ureteric injury." BJU International 128(5): 539-547 https://bjui-journals.onlinelibrary.wiley.com/doi/abs/10.1111/bju.15404 PDF AT LINK
Injuries to the bladder and ureter are uncommon but usually require prompt urological management. Due to their infrequent nature, Urologists maybe unfamiliar with managing these acute problems and may not work in specialist centres with readily available expertise in open and abdominal surgery. We aim to provide advice in the form of a consensus statement led by the Female, Neurological and Urodynamic Urology (FNUU) Section of the British Association of Urological Surgeons (BAUS), in consultation with BAUS members and consultants working in units throughout the UK, to create a comprehensive management pathway and a series of statements to aid clinicians.
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