ENDOSCOPIC RENDEZ-VOUS OF A COMPLETE IATROGENIC DETACHMENT OF THE RIGHT URETER

Abstract

Iatrogenic injury to the urinary tract during pelvic and retroperitoneal surgery occurs most commonly to the ureters followed by the bladder and urethra. Injury to the ureter is the most common urologic complication of pelvic surgery with an incidence ranging from 1 to 10%.
A Caucasian female patient, 42 years old submitted to laparoscopic hysterectomy on March 2011. 7 days after discharge she went to the emergency room for right flank pain and performed a CT scan showing a complete detachment of the right ureter, 2.5 cm from the ureterovesical junction. A right nephrostomy was placed and a fluoroscopic contrast control showed the complete ureteral detachment.
The patient was then sent to our observation for a ureteral reimplantation surgery, and a minimally invasive endoscopic treatment was performed (ante-retrograde endoscopic rendez vous). Under fluoroscopic control, a 0.035 inches J-shaped guidewire is inserted through the nephrostomy to reach the ureteral lesion; we proceed to the ureteroscopic retrieval, with grasping forceps, of the end of the guide wire thus to realign the ureter by a double J 4.7 ch ureteral stenting. After 15 days nephrostomy was removed while the JJ was left in the ureter for 3 months.