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Harnleiterrekonstruktion nach ureterorenoskopischen Verletzungen

Ureteral reconstruction after ureterorenoscopic injuries

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Zusammenfassung

Harnleiterverletzungen werden in ca. 75% der Fälle iatrogen verursacht. Von den urologischen Verletzungsmustern wird am häufigsten die Ureterorenoskopie (URS) beschrieben, wobei die Komplikationsrate der URS insgesamt gering ist. Nach der „American Association for the Surgery of Trauma“ (AAST) werden Ureterverletzungen in 5 Schweregrade eingeteilt. Grad I–II werden als partielle und Grad III–V als komplexe Verletzungen bezeichnet. Zur Vermeidung von höheren Komplikationsraten sollte eine möglichst schnelle Diagnosestellung und Therapieeinleitung erfolgen. Die Therapie richtet sich dabei nach Schweregrad der Verletzung.

Partielle Harnleiterverletzungen werden endoskopisch durch Harnleiterschienung für 14–21 Tage behandelt. Bei komplexen Harnleiterverletzungen kann eine endoskopische Ureteroureterostomie versucht werden. Diese zeigt jedoch abhängig von der Länge der Diskontinuitätsverletzung schlechte Langzeitergebnisse.

Zur operativen Rekonstruktion des Harnleiters werden Techniken mit und ohne Verwendung von Darmsegmenten beschrieben. Die Art der operativen Technik ist dabei abhängig von Lage und Ausmaß der Verletzung. Neben der Harnleiterrekonstruktion kann in Einzelfällen eine Autotransplantation der Niere notwendig sei.

Abstract

Ureteral injuries are caused by iatrogenic reasons in about 75% of cases. Among urological procedures ureterorenoscopy (URS) is mainly described as the reason for ureteral injury, although complication rates of URS are generally low. Injuries of the ureter are divided into five grades by the AAST. Grades I–II are referred to as partial and grades III–V as complex ureteral injuries. To avoid higher complication rates there should be no delay in confirmation of diagnosis and initiation of therapy. Correct therapy depends on grade of injury.

Partial ureteral injuries are treated by endoscopic inlay of a ureteral stent for approximately 14–21 days. In complex injuries endoscopic ureteroureterostomy could be attempted but leads to rather poor long-term results depending on the length of devascularization of the injured ureter.

Procedures with and without use of bowel for ureteral reconstruction and replacement have been described. The type of operative procedure should be selected based on location and degree of ureteral injury. Besides ureteral reconstruction, autotransplantation of the affected kidney can be required in individual cases.

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Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Correspondence to Dr. A.S. Brandt.

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Brandt, A., von Rundstedt, F., Lazica, D. et al. Harnleiterrekonstruktion nach ureterorenoskopischen Verletzungen. Urologe 49, 812–821 (2010). https://doi.org/10.1007/s00120-010-2333-5

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Schlüsselwörter

  • Harnleiter
  • Harnleiterverletzungen
  • Ureterorenoskopie
  • Komplikationen
  • Harnleiterrekonstruktion

Keywords

  • Ureter
  • Ureteral injuries
  • Ureterorenoscopy
  • Complications
  • Ureteral reconstruction