URETERAL STENTING WITH URO-RADIOLOGICAL COMBINED MANEUVER IN IATROGENIC URETERAL INJURIES

Pubblicato da il Mar 18, 2013 in | Commenti disabilitati su URETERAL STENTING WITH URO-RADIOLOGICAL COMBINED MANEUVER IN IATROGENIC URETERAL INJURIES

==inizio abstract==

Objective

The aim of the present study is to present our JJ stenting technique in ureteral iatrogenic injuries in patients with non suitable to reconstructive surgery

Methods and results

From 2009 to 2012 three patients undergone adjuvant radiotherapy plus radical hysteroannessiectomy for endometrial cancer were evaluated for anuria (2/3 patients)or sepsis (1/3). CT-urography demonstrated the avulsion of an ureter. In urgency regimen it was placed nephrostomic catether in involved kidney. All patients were non suitable to an open ureterocistoneostomy or ureteral repair due to very low performance status. After general clinical stabilization it was performed a combineduro-radiological maneuver to place a JJ stent. Cystoscopically, the distal ureteral segment was cannulated and a guidewire was advanced into the urinoma. An angiographic catheter was then advanced over the guidewire to the site of rupture. A guidewire was then placed through the indwelling nephrostomy tube and an Amplatz gooseneck snare was placed antegrade into the urinoma cavity. The guidewire was grasped from below by the snare and pulled through the percutaneous access site. A 6F double J ureteral stent was then placed. Nephrostomy was removed on postoperative day 10.
Mean operative time (range) was 8.4 (5-12) minutes. At a mean (range) follow-up of 12.3 (8-16) months all the three patients demonstrated a conserved renal function. Due to very low performance status and local tumoral progression it was indicated the maintenance of ureteral stents that are substituted every 6 months. A retrograde pielography performed during substitutions demontrated the absence of uretheral defects in 2/3 patients.

Discussion

Double J stenting with uro-radiological combined maneuver is an effective and safe approach to ureteral iatrogenic injuries. The minimally invasive aspect of this procedure may be considered whenever a patients presents critical clinical and surgical conditions that contraindicate ureterocystoneostomy.

==fine abstract==