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Rezidiveingriffe an den Beckenarterien nach alloplastischen Rekonstruktionen

Interdisziplinäres Management von Ureterläsionen

Revision surgery on the pelvic arteries following alloplastic reconstruction

Interdisciplinary management of lesions of the ureter

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Zusammenfassung

5,7% aller gefäßchirurgischen Rekonstruktionen in der Beckenetage gehen mit einer Harnleiterläsion einher. Diese werden zu 66% postoperativ diagnostiziert. Bei gefäßchirurgischen Rezidivoperationen in der Beckenetage scheint die Verletzungsrate des Ureters ungleich höher. Wir stellen 3 Patienten vor, bei denen es im Rahmen von Rezidivoperationen mit alloplastischer Rekonstruktion der Beckenarterien zur Ureterverletzung kam. Es wird ein durch uns erarbeitetes Therapiekonzept für solche Komplikationen vorgestellt. Bei zu erwartendem ausgedehntem reaktiv-fibrotischem Operationssitus empfiehlt sich die präoperative Implantation von Ureterschienen, die die Identifikation des Ureters erleichtern. Bei Verletzungen des unteren Harnleiterdrittels erfolgt die Rekonstruktion durch eine Psoas-hitch-Blasenplastik, in seltenen Fällen durch die Ureteroureterostomie (End-zu-End). Solche Eingriffe erfordern hinsichtlich Planung und Operation eine enge Kooperation zwischen Gefäßchirurgie und Urologie.

Abstract

Of all vascular reconstructions at the pelvic level, 5.7% are associated with a lesion to the ureter. These are detected postoperatively in 66% of cases. The injury rate seems to be incomparably higher in redo vascular surgical procedures performed on iliac vessels. We report on three patients in whom ureter injuries were caused in the course of revision operations with alloplastic reconstruction of aortic or iliac vessels. We then present the treatment scheme we have elaborated for use in such cases. When severe adhesions are expected we recommend preoperative implantation of an intraureteric stent, which helps to identify the ureter during preparation. The psoas hitch plasty is used for reconstruction in the case of injuries to the lower third of the ureter. Ureteroureterostomy (end-to-end) is performed in such cases only rarely. The need for close cooperation between vascular surgeon and urologist during planning and surgery is emphasized.

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Literatur

  1. Adams JR Jr, Mata J, Culkin DJ, Venable DD (1992) Ureteral injury in abdominal vascular reconstructive surgery. Urology 39(1): 77–81

    Article  PubMed  Google Scholar 

  2. Arango Toro O, Bielsa Gali O, Coradellas Angel R et al. (1997) Surgical solutions to iatrogenic ureteral lesions in 31 cases. Actas Urol Esp 21(2): 133–139

    Google Scholar 

  3. Benoit L, Spie R, Favoulet P et al. (2005) Prise en charge des lésions urétérales iatrogènes. Ann Chir 130(8): 451–457

    Article  PubMed  CAS  Google Scholar 

  4. Clemens L, Bernardini S, Chabannes E, Debiere F, Bittard H (2000) Ureteral lesions after surgery of the aortic bifurcations. Report of 6 cases. Prog Urol 10(6): 1156−1160

    PubMed  CAS  Google Scholar 

  5. Dalsing MC, Bihrle R, Lalka SG, Cikrit DF, Sawchuk AP (1993) Vascular surgery-associated ureteral injury: zebras do exist. Ann Vasc Surg 7(2): 180–186

    Article  PubMed  CAS  Google Scholar 

  6. Guttikonda S, Vitellas K (2002) Ureteral leak after an abdominal aortic aneurysm repair: case report. Emerg Radiol 9(2): 103–105

    PubMed  Google Scholar 

  7. Houdelette R, Dumotier J, Daigremont H, Garola P (1989) Le risque urétéral de la chirurgie aorto-iliaque: A propos d’une observation de lésion bilatérale des uretères. Ann Urol 23(6): 509–511

    CAS  Google Scholar 

  8. Mianne D, Bertrand S, N’Guyen P (1997) Les plaies non iatrogènes de l’uretère. Ann Urol 31: 281–287

    CAS  Google Scholar 

  9. Nachbur B, Marincek B, Jakob R, Ackerman D (1989) The impact of computed tomography in the diagnosis and postoperative follow-up of ureteric obstruction in aorto-iliac aneurysmal disease. Eur J Vasc Surg 3(6): 475–492

    Article  PubMed  CAS  Google Scholar 

  10. Paick JS, Hong SK, Park MS, Kim SW (2006) Management of postoperatively detected iatrogenic lower ureteral injury: should ureteroureterostomy really be abandoned? Urology 67(2): 237–241

    Article  PubMed  Google Scholar 

  11. Richardson JW, Greenfield LJ (1988) Natural history and management of iliac aneurysms. J Vasc Surg 8(2): 165–171

    Article  PubMed  CAS  Google Scholar 

  12. Ballesteros Sampol JJ, Vidal Barraquer F, Guzman Fernandez A, Pares Puntas M (2001) Ureteral complications of retroperitoneal prosthetic vascular surgery. Actas Urol Esp 25(1): 55–59

    Google Scholar 

  13. Schapira HE, Li R, Gribetz M, Wulfsohn MA, Brendler H (1981) Ureteral injuries during vascular surgery. J Urol 125(3): 293–297

    PubMed  CAS  Google Scholar 

  14. Sheehan MK, Shireman PK, Littooy FN, Baker WH (2001) Ureteral injury during aortic aneurysm repair by the retroperitoneal approach. Ann Vasc Surg 15(4): 481–484

    Article  PubMed  CAS  Google Scholar 

  15. Spirnak JP, Hampel N, Resnick MI (1989) Ureteral injuries complicating vascular surgery: is repair indicated? J Urol 141(1): 13–14

    PubMed  CAS  Google Scholar 

  16. Teber D, Egey A, Gözen AS, Rassweiler J (2005) Harnleitertrauma. Urologe 44: 870–877

    Article  PubMed  CAS  Google Scholar 

  17. Watterson JD, Mahoney JE, Futter NG, Gaffield J (1998) Iatrogenic ureteric injuries: approaches to etiology and management. Can J Surg 41(5): 379–382

    PubMed  CAS  Google Scholar 

  18. York JW, Money SR (2001) Prevention and management of ureteral injuries during aortic surgery. Semin Vasc Surg 14(4): 266–274

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53125, Bonn, Deutschland

    A. Koscielny, F. Verrel, A. Hirner & M. Kaminski

  2. Klinik und Poliklinik für Urologie, Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland

    G. Fechner

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  1. A. Koscielny
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  2. G. Fechner
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  3. F. Verrel
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  4. A. Hirner
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  5. M. Kaminski
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Correspondence to A. Koscielny.

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Koscielny, A., Fechner, G., Verrel, F. et al. Rezidiveingriffe an den Beckenarterien nach alloplastischen Rekonstruktionen. Gefässchirurgie 12, 444–448 (2007). https://doi.org/10.1007/s00772-007-0552-x

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  • DOI: https://doi.org/10.1007/s00772-007-0552-x

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