Download PDF
Clin Colon Rectal Surg 2003; 16(1): 027-038
DOI: 10.1055/s-2003-39035
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Urinary Tract Injuries: Recognition and Management

John C. Hairston1 , Gamal M. Ghoniem2
  • 1Division of Urology, University of Texas Medical School-Houston, Houston, Texas
  • 2Section of Female Urology, Voiding Dysfunction and Pelvic Reconstruction, Cleveland Clinic Florida, Weston, Florida
Further Information

Publication History

Publication Date:
07 May 2003 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Iatrogenic injury to the urinary tract can be caused by any surgeon operating in or around the pelvis and the retroperitoneal abdominal space. This includes gynecologists, general surgeons, urologists, vascular surgeons, neurosurgeons, and orthopedic surgeons. The urinary tract is extremely vulnerable to intraoperative injury for a variety of reasons. Operating in a hostile environment such as that encountered with repeat surgeries, significant inflammation, and large neoplasms puts the urinary tract at even greater risk. There are a large variety of techniques for repair/reconstruction of the injured ureter, bladder, or urethra. Without a doubt, the most important aspect in the outcome of iatrogenic urinary tract injury is prompt recognition and diagnosis. Lack of recognition at the time of injury often mandates additional surgical procedures with their associated morbidity and may result in loss of renal function, or worse, loss of a renal unit. Thus it is essential that every surgeon operating in this space be familiar with urinary anatomy and basic diagnostic and reconstructive techniques.

KEYWORDS

Iatrogenic - urinary tract - laparoscopy - intraoperative - complication

REFERENCES

  • 1 Higgins C C. Ureteral injuries during surgery. A review of 87 cases.  JAMA . 1967;  199 82-88
    CrossrefPubMedSearch in Google Scholar
  • 2 Daly J W, Higgins K A. Surg Gynecol Obstet .  1988;  167 19-22
    PubMedSearch in Google Scholar
  • 3 Goodno Jr A J, Powers T W, Harris V D. Ureteral injury in gynecologic surgery: a ten-year review in a community hospital.  Am J Obstet Gynecol . 1995;  172 1817-1820
    CrossrefPubMedSearch in Google Scholar
  • 4 Liapis A, Bakas P, Giannopoulos V. et al . Ureteral injuries during gynecological surgery.  Int Urogynecol J Pelvic Floor Dysfunct . 2001;  12 391-393
    CrossrefPubMedSearch in Google Scholar
  • 5 St Lezin A M, Stoller M L. Surgical ureteral injuries.  Urology . 1991;  38 497-506
    CrossrefPubMedSearch in Google Scholar
  • 6 Neuman M, Eidelman A, Langer R. et al . Iatrogenic injuries to the ureter during gynecologic and obstetric operations.  Surg Gynecol Obstet . 1991;  173 268-272
    PubMedSearch in Google Scholar
  • 7 Alexander S, Cass M B, Bubrick M P. Ureteral injuries in colonic surgery.  Urology . 1981;  18 359-364
    CrossrefPubMedSearch in Google Scholar
  • 8 Gangai M P, Agee R E, Spence C R. Surgical injury to the ureter.  Urology . 1976;  8 22-27
    CrossrefPubMedSearch in Google Scholar
  • 9 Dowling R A, Corriere J N, Sandler C M. Iatrogenic ureteral injury.  J Urol . 1986;  135 912-915
    PubMedSearch in Google Scholar
  • 10 O'Brien W M, Maxted W C, Pahira J J. Ureteral stricture: experience with 31 cases.  J Urol . 1988;  140 737-740
    PubMedSearch in Google Scholar
  • 11 Assimos D G, Patterson L C, Taylor C L. Changing incidence and etiology of iatrogenic ureteral injuries.  J Urol . 1994;  152(6 Pt 2) 2240-2246
    PubMedSearch in Google Scholar
  • 12 Selzman A A, Spirnak J P. Iatrogenic ureteral injuries: a 20-year experience in treating 165 injuries.  J Urol . 1996;  155 878-881
    CrossrefPubMedSearch in Google Scholar
  • 13 Tamussino K F, Lang P F, Breinl E. Ureteral complications with operative gynecologic laparoscopy.  Am J Obstet Gynecol . 1998;  178 967-970
    PubMedSearch in Google Scholar
  • 14 Vallancian G, Cathelineau X, Baumert H. et al . Complications of transperitoneal laparoscopic surgery in urology: review of 1,311 procedures at a single center.  J Urol . 2002;  168 23-26
    PubMedSearch in Google Scholar
  • 15 Morey A F, McAninch J W, Tiller B K. et al . Single shot intraoperative excretory urography for the immediate evaluation of renal trauma.  J Urol . 1999;  161 1088-1092
    PubMedSearch in Google Scholar
  • 16 Ghali A M, El Malik M E, Ibrahim A I. Ureteric injuries: diagnosis, management, and outcome.  J Trauma . 1999;  46 150-158
    CrossrefPubMedSearch in Google Scholar
  • 17 Flynn J T, Tiptaft R C, Woodhouse C R. The early and aggressive repair of iatrogenic ureteric injuries.  Br J Urol . 1979;  51 454-457
    PubMedSearch in Google Scholar
  • 18 Blandy J P, Badenoch D F, Fowler C G. Early repair of iatrogenic injury to the ureter or bladder after gynecological surgery.  J Urol . 1991;  146 761-765
    PubMedSearch in Google Scholar
  • 19 Carlton Jr E C, Scott Jr R, Guthrie A G. Surgical correction of ureteral injuries.  J Trauma . 1969;  9 457-464
    PubMedSearch in Google Scholar
  • 20 Guiter J, Cuenant E, Mourad G. et al . Re-establishment of urinary continuity by uretero-ureterostomy in renal transplantation. Apropos of 135 cases.  J Urol (Paris) . 1985;  91 27-32
    PubMedSearch in Google Scholar
  • 21 Stefanovic K B, Bukurov N S, Marinkovic J M. Non-antireflux versus antireflux ureteroneocystostomy in adults.  Br J Urol . 1991;  67 263-266
    PubMedSearch in Google Scholar
  • 22 Turner-Warwick R T, Worth P HL. The psoas bladder-hitch procedure for the replacement of the lower third of the ureter.  Br J Urol . 1969;  41 701-709
    PubMedSearch in Google Scholar
  • 23 Riedmiller H, Becht E, Hertle L. et al . Psoas-hitch ureteroneocystostomy: experience with 181 cases.  Eur Urol . 1984;  10 145-150
    PubMedSearch in Google Scholar
  • 24 Franke J L, Smith Jr A J. Surgery of the ureter. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Campbell's Urology Philadelphia: W.B. Saunders 1998: 3062-3084
    Search in Google Scholar
  • 25 Bowsher W G, Shah P J, Costello A J. A critical appraisal of the Boari flap.  Br J Urol . 1982;  54 682-685
    PubMedSearch in Google Scholar
  • 26 Motiwala H G, Shah S A, Patel S M. Ureteric substitution with Boari bladder flap.  Br J Urol . 1990;  66 369-371
    PubMedSearch in Google Scholar
  • 27 Gallentine M L, Harmon W J. Ureteral substitution with a stapled neoureter: a simplified Boari flap.  J Urol . 2001;  166 1869-1872
    PubMedSearch in Google Scholar
  • 28 Higgins C C. Transuretero-ureteral anastomosis: Report of a clinical case.  Trans Am Assoc Genitourin Surg . 1934;  27 279
    PubMedSearch in Google Scholar
  • 29 Hendren W H, Hensle T W. Transureteroureterostomy: experience with 75 cases.  J Urol . 1980;  123 826-833
    PubMedSearch in Google Scholar
  • 30 Harada N, Tanimura M, Fukuyama K. et al . Surgical management of a long ureteral defect: advancement of the ureter by descent of the kidney.  J Urol . 1964;  92 192-197
    PubMedSearch in Google Scholar
  • 31 Goldwasser B, Leibovitch I, Avigad I. Ureteral substitution using the isolated interposed vermiform appendix in a patient with a single kidney and transitional cell carcinoma of the ureter.  Urology . 1994;  44 437-440
    CrossrefPubMedSearch in Google Scholar
  • 32 Vidne B, Erdman S, Gassner S. et al . Ureteral substitute by fallopian tube. Experimental study.  Urol Int . 1975;  30 173-180
    PubMedSearch in Google Scholar
  • 33 Boxer R J, Fritzsche P, Skinner D G. et al . Replacement of the ureter by small intestine: clinical application and results of the ileal ureter in 89 patients.  Trans Am Assoc Genitourin Surg . 1978;  70 99-102
    PubMedSearch in Google Scholar
  • 34 Verduyckt F, Heesakkers J, Debruyne F. Long-term results of ileum interposition for ureteral obstruction.  Eur Urol . 2002;  42 181-187
    CrossrefPubMedSearch in Google Scholar
  • 35 Koch M O, McDougal W S. The pathophysiology of hyperchloremic metabolic acidosis after urinary diversion through intestinal segments.  Surgery . 1985;  98 561-570
    PubMedSearch in Google Scholar
  • 36 Waldner M, Hertl L, Roth S. Ileal ureteral substitution in reconstructive urological surgery: is an antireflux procedure necessary?.  J Urol . 1999;  162 323-326
    CrossrefPubMedSearch in Google Scholar
  • 37 Bodie B, Novick A C, Rose M. et al . Long-term results with renal autotransplantation for ureteral replacement.  J Urol . 1986;  136 1187-1189
    PubMedSearch in Google Scholar
  • 38 Bothwell W N, Bleicher R J, Dent T L. Prophylactic ureteral catheterization in colon surgery. A five-year review.  Dis Colon Rectum . 1994;  37 330-334
    CrossrefPubMedSearch in Google Scholar
  • 39 Kuno K, Menzin A, Kauder H H. et al . Prophylactic ureteral catheterization in gynecologic surgery.  Urology . 1998;  52 1004-1008
    CrossrefPubMedSearch in Google Scholar
  • 40 Sheikh F A, Khubchandani I T. Prophylactic ureteric catheters in colon surgery-how safe are they?.  <~>Report of three cases. Dis Colon Rectum . 1990;  33 508-510
    PubMedSearch in Google Scholar
  • 41 Ostrzenski A, Ostrzenska K M. Bladder injury during laparoscopic surgery.  Obstet Gynecol Surv . 1998;  53 175-180
    CrossrefPubMedSearch in Google Scholar
  • 42 Deck A J, Shaves S, Talner L. et al . Current experience with computed tomographic cystography and blunt trauma.  World J Surg . 2001;  25 1592-1596
    PubMedSearch in Google Scholar
  • 43 Misra D, Chana J, Drake D P. et al . Operative trauma to the genitourinary tract in the treatment of anorectal malformations: 15 years' experience.  Urology . 1996;  47 559-562
    CrossrefPubMedSearch in Google Scholar
  • 44 Tanagho E A. Urethrosphincteric reconstruction for congenitally absent urethra.  J Urol . 1976;  116 237-242
    PubMedSearch in Google Scholar
  • 45 Ghoniem G M, Monga M. Modified pubovaginal sling and Martius graft for repair of the recurrent vesicovaginal fistula involving the internal urinary sphincter.  Eur Urol . 1995;  27 241-245
    PubMedSearch in Google Scholar
  • 46 Webster G D, Mathes G L, Selli C. Prostatomembranous urethral injuries: a review of the literature and a rational approach to their management.  J Urol . 1983;  130 898-902
    PubMedSearch in Google Scholar
  • 47 Fujita O E, Dinlenc C, Kavoussi L. The laparoscopic Boari flap.  J Urol . 2001;  166 51-53
    PubMedSearch in Google Scholar
  • 48 Fergany A, Gill I S, Abdel-Samee A. et al . Laparoscopic bladder flap ureteral reimplantation: survival porcine study.  J Urol . 2001;  166 1920-1923
    PubMedSearch in Google Scholar
  • 49 Reddy P K, Evans R M. Laparoscopic ureteroneocystostomy.  J Urol . 1994;  152(6 Pt 1) 2057-2059
    PubMedSearch in Google Scholar
  • 50 Gill I S, Savage S J, Senagore A J. et al . Laparoscopic ileal ureter.  J Urol . 2000;  163 1199-1202
    PubMedSearch in Google Scholar
  • 51 Anderson K R, Clayman R V. Laparoscopic lower urinary tract reconstruction.  World J Urol . 2000;  18 349-354
    CrossrefPubMedSearch in Google Scholar
  • 52 Cottam D, Gorecki P J, Curvelo M. et al . Laparoscopic repair of traumatic perforation of the urinary bladder.  Surg Endosc . 2001;  15 1488-1489
    CrossrefPubMedSearch in Google Scholar
  • 53 Atala A. Tissue engineering in urology.  Curr Urol Rep . 2001;  2 83-92
    PubMedSearch in Google Scholar
  • 54 Atala A. Future trends in bladder reconstructive surgery.  Semin Pediatr Surg . 2002;  11 134-142
    CrossrefPubMedSearch in Google Scholar