Does Endourological Intervention a Suitable Treatment Options in
Management of Iatrogenic Thermal Ureteral Injury?
Introduction This study aimed to evaluate the etiological factors and
their effects on long-term clinical outcomes in patients with iatrogenic
ureteral injury (IUI). Material and Method Twenty-seven patients who
underwent surgery because of IUI were evaluated between January 2011 and
April 2018. Patients were classified according to the time of diagnosis
and the need for reoperation after the urologic intervention. The IUI
cases detected during gynecological surgery were called ‘perioperative’
IUI, and those diagnosed late as ‘postoperative’ (delayed) IUI. The IUI
type was categorized as ‘cold transection’ due to surgical dissection or
ligation and ‘thermal injury’ if it depended on any energy-based
surgical device. Results Postoperative diagnosed cases consisted of
exclusively after laparoscopic surgery (p=.025). Patients with thermal
injury to the ureter were mostly diagnosed postoperatively (p= .021).
Patients who underwent endourological intervention, 31.25% (N = 5/16)
were diagnosed during gynecologic surgery, and 68.75% (n = 11/16) were
diagnosed postoperatively. For open reconstructive surgery, these rates
were observed to be 72.72% (n = 8/11) and 27.28% (n = 3/11),
respectively (p=.034). IUI was due to thermal injury in all patients who
developed complications after the urological intervention (p = .046),
and the first urological intervention was endoscopic double loop
stenting (p = .005). One of these patients was diagnosed in the
perioperative period and seven in the postoperatively (p = .016).
Conclusion Treatment success rates are low in patients who underwent
endourological intervention after thermal IUI. Therefore, surgical
techniques in which the traumatic ureter segment is excised should be
preferred to avoid complications. Key Words Ureter, Iatrogenic, Thermal
Injury, Iatrogenic Ureteral Injury, Endourological Intervention.