Beklenmeyen İyatrojenik Üreteral Yaralanmaya Bağlı Rekonstrüksiyonun Sonuçları

Abstract

RESULTS OF RECONSTRUCTION DUE TO UNEXPECTED IATROGENIC URETERAL INJURY

Aim: Iatrogenic traumas are known to be the most common cause of ureteral injuries. This study aimed to evaluate the results of surgical reconstruction performed due to unexpected iatrogenic ureteral injuries. Methods: The results of reconstruction due to unexpected ureteric injuries occurring during non-urological procedures were analyzed retrospectively. Patients with hydronephrosis, follow-up of less than 3 months, and those consulted to urology preoperatively were excluded. The ureteral injury was diagnosed either intraoperatively, or in the postoperative one-month period. Intraoperative diagnoses were followed by intraoperative reconstruction, whereas the second group was operated in the postoperative six-month period. Failure was defined as hydronephrosis/renal atrophy and long-term stenting. Factors that may be associated with failure were evaluated. Results: A total of 50 ureteral reconstructions were performed due to unexpected ureteral injury in non-urological operations. Median age and follow-up time were 51 (19-76) years and 25 (3-186) months. Intraoperative and postoperative ureteral injury was diagnosed in 27 (54%) and 23 (46%) patients, respectively. Rate of failure was 22% (11/50). In univariate analyses, prior abdominal surgery, chemotherapy, clinic (gynecology/non-gynecology), time of diagnosis(intra/postoperative), and pathology (benign/malign) were significant factors for failure (p=0.037, p=0.004, p=0.014, p=0.036 and p=0.002; respectively). Malign pathology was the sole significant on multivariate analysis (p=0.010, OR:8.846 (1.676-46.690)). Conclusions: Surgery due to malignant disease is a risk factor for failure of ureteral reconstruction due to unexpected iatrogenic ureteral injury.