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Outcomes of ureteroscopic double-J ureteral stenting for distal ureteral injury after gynecologic surgery

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Abstract

Introduction and hypothesis

Ureteral injuries are well-known complications of any gynecologic surgery. We evaluated the safety and feasibility of ureteroscopic double-J (DJ) ureteral stenting in patients with distal ureteral injuries after gynecologic surgery.

Methods

Eleven consecutive patients with an iatrogenic ureteral injury in the distal ureter secondary to gynecologic surgery underwent DJ ureteral stenting between March 2008 and January 2016. Ureteral leakage and stricture were appraised using intravenous pyelography. The operative and clinical outcomes were evaluated.

Results

The DJ ureteral stent was successfully inserted using ureteroscopy in all patients, none of whom showed major or minor complications during the intraoperative and perioperative follow-up periods. Intravenous pyelography performed every 3 months during the follow-up period verified recovery at the ureteral injury site, without urine leakage. However, five patients experienced ureteral stricture. Balloon dilatation or Holmium laser endoureterotomy was performed successfully in all patients. One patient with recurring ureteral stricture was retreated using Holmium laser endoureterotomy and balloon dilatation; during 12 months of follow-up, there was no recurrence. Overall long-term success rate was 100%, with a mean follow-up of 20.4 months.

Conclusion

DJ stenting using ureteroscopy diminishes the necessity for invasive surgical procedures and is regarded as one of the available management options for patients with an iatrogenic ureteral injury before considering an invasive operation. However, since ureteral stricture frequently occurs after ureteroscopic procedures, it is essential to select the appropriate patients.

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Abbreviations

PCN:

Percutaneous nephrostomy

DJ:

Double-J

References

  1. Engel T, Reid RA, Thompson HE. Laparoscopy in gynecology. Rocky Mt Med J. 1971;68(8):11–6.

    PubMed  CAS  Google Scholar 

  2. Adelman MR, Bardsley TR, Sharp HT. Urinary tract injuries in laparoscopic hysterectomy: a systematic review. J Minim Invasive Gynecol. 2014;21(4):558–66. https://doi.org/10.1016/j.jmig.2014.01.006.

    Article  PubMed  Google Scholar 

  3. Han CM, Tan HH, Kay N, Wang CJ, Su H, Yen CF, et al. Outcome of laparoscopic repair of ureteral injury: follow-up of twelve cases. J Minim Invasive Gynecol. 2012;19(1):68–75. https://doi.org/10.1016/j.jmig.2011.09.011.

    Article  PubMed  CAS  Google Scholar 

  4. Doll KM, Milad MP, Gossett DR. Surgeon volume and outcomes in benign hysterectomy. J Minim Invasive Gynecol. 2013;20(5):554–61. https://doi.org/10.1016/j.jmig.2013.03.005.

    Article  PubMed  Google Scholar 

  5. Vree FE, Cohen SL, Chavan N, Einarsson JI. The impact of surgeon volume on perioperative outcomes in hysterectomy. JSLS. 2014;18(2):174–81. https://doi.org/10.4293/108680813X13753907291594.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Liapis A, Bakas P, Giannopoulos V, Creatsas G. Ureteral injuries during gynecological surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(6):391–3. discussion 4

    Article  PubMed  CAS  Google Scholar 

  7. Harkki-Siren P, Sjoberg J, Tiitinen A. Urinary tract injuries after hysterectomy. Obstet Gynecol. 1998;92(1):113–8.

    Article  PubMed  CAS  Google Scholar 

  8. Dandolu V, Mathai E, Chatwani A, Harmanli O, Pontari M, Hernandez E. Accuracy of cystoscopy in the diagnosis of ureteral injury in benign gynecologic surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(6):427–31. https://doi.org/10.1007/s00192-003-1095-7.

    Article  PubMed  Google Scholar 

  9. Wu MP, Lin YS, Chou CY. Major complications of operative gynecologic laparoscopy in southern Taiwan. J Am Assoc Gynecol Laparosc. 2001;8(1):61–7.

    Article  PubMed  CAS  Google Scholar 

  10. Gilmour DT, Das S, Flowerdew G. Rates of urinary tract injury from gynecologic surgery and the role of intraoperative cystoscopy. Obstet Gynecol. 2006;107(6):1366–72. https://doi.org/10.1097/01.AOG.0000220500.83528.6e.

    Article  PubMed  CAS  Google Scholar 

  11. Janssen PF, Brolmann HA, Huirne JA. Recommendations to prevent urinary tract injuries during laparoscopic hysterectomy: a systematic Delphi procedure among experts. J Minim Invasive Gynecol. 2011;18(3):314–21. https://doi.org/10.1016/j.jmig.2011.01.007.

    Article  PubMed  CAS  Google Scholar 

  12. Ibeanu OA, Chesson RR, Echols KT, Nieves M, Busangu F, Nolan TE. Urinary tract injury during hysterectomy based on universal cystoscopy. Obstet Gynecol. 2009;113(1):6–10. https://doi.org/10.1097/AOG.0b013e31818f6219.

    Article  PubMed  Google Scholar 

  13. Chou MT, Wang CJ, Lien RC. Prophylactic ureteral catheterization in gynecologic surgery: a 12-year randomized trial in a community hospital. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(6):689–93. https://doi.org/10.1007/s00192-008-0788-3.

    Article  PubMed  Google Scholar 

  14. Ku JH, Kim ME, Jeon YS, Lee NK, Park YH. Minimally invasive management of ureteral injuries recognized late after obstetric and gynaecologic surgery. Injury. 2003;34(7):480–3.

    Article  PubMed  Google Scholar 

  15. Seseke F, Heuser M, Zoller G, Plothe KD, Ringert RH. Treatment of iatrogenic postoperative ureteral strictures with Acucise endoureterotomy. Eur Urol. 2002;42(4):370–5.

    Article  PubMed  Google Scholar 

  16. De Cicco C, Schonman R, Craessaerts M, Van Cleynenbreugel B, Ussia A, Koninckx PR. Laparoscopic management of ureteral lesions in gynecology. Fertil Steril. 2009;92(4):1424–7. https://doi.org/10.1016/j.fertnstert.2008.08.021.

    Article  PubMed  Google Scholar 

  17. Margossian H, Falcone T, Walters MD, Biscotti C. Laparoscopic repair of ureteral injuries. J Am Assoc Gynecol Laparosc. 2003;10(3):373–7.

    Article  PubMed  Google Scholar 

  18. Pettit PD, Petrou SP. The value of cystoscopy in major vaginal surgery. Obstet Gynecol. 1994;84(2):318–20.

    PubMed  CAS  Google Scholar 

  19. Saidi MH, Sadler RK, Vancaillie TG, Akright BD, Farhart SA, White AJ. Diagnosis and management of serious urinary complications after major operative laparoscopy. Obstet Gynecol. 1996;87(2):272–6.

    Article  PubMed  CAS  Google Scholar 

  20. Macri A, Magno C, Certo A, Basile A, Scuderi G, Crescenti F, et al. Combined antegrade and retrograde ureteral stenting: the rendezvous technique. Clin Radiol. 2005;60(2):257–60. https://doi.org/10.1016/j.crad.2004.06.008.

    Article  PubMed  CAS  Google Scholar 

  21. Pastore AL, Palleschi G, Silvestri L, Leto A, Autieri D, Ripoli A, et al. Endoscopic rendezvous procedure for ureteral iatrogenic detachment: report of a case series with long-term outcomes. J Endourol. 2015;29(4):415–20. https://doi.org/10.1089/end.2014.0474.

    Article  PubMed  Google Scholar 

  22. Doyle PJ, Lipetskaia L, Duecy E, Buchsbaum G, Wood RW. Sodium fluorescein use during intraoperative cystoscopy. Obstet Gynecol. 2015;125(3):548–50. https://doi.org/10.1097/AOG.0000000000000675.

    Article  PubMed  CAS  Google Scholar 

  23. Kim JS, Lee DH, Suh HJ. Double-J stenting: initial management of injured ureters recognized late after gynecological surgery. Int Urogynecol J. 2010;21(6):699–703. https://doi.org/10.1007/s00192-009-1092-6.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 59 Dongsu-ro, Bupyeng-gu, Incheon, Korea

    Yong Sun Choi, Dong Hwan Lee & Kang Sup Kim

  2. Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

    Sung Hyun Lee

  3. Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Hyuk Jin Cho

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  1. Yong Sun Choi
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  2. Sung Hyun Lee
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  3. Hyuk Jin Cho
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  4. Dong Hwan Lee
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Correspondence to Kang Sup Kim.

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Choi, Y.S., Lee, S.H., Cho, H.J. et al. Outcomes of ureteroscopic double-J ureteral stenting for distal ureteral injury after gynecologic surgery. Int Urogynecol J 29, 1397–1402 (2018). https://doi.org/10.1007/s00192-017-3478-1

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  • DOI: https://doi.org/10.1007/s00192-017-3478-1

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