Management of Iatrogenic Ureteral Injuries Analysis Report at Urology Department, Nishtar Hospital Multan

Abstract

Place and Duration of study: The study was carried out at Department of Urology, Nishtar Hospital, Multan from 
December 2007 to December 2010. 
Patients and methods: A total of 24 adult patients were included in the study. All patients were evaluated in terms 
of clinical presentation, physical examination and investigations. Different techniques including open repair and 
endoscopic maneuvers were performed as treatment modalities for ureteric injuries. 
Results:- Out of 24 patients, 13 patients were female and 11 patients were males. Age of patients ranged from 20 
years to 60 years. Out of 13 female patients, eleven developed  lower ureteral injuries secondary to obstetrics and 
gynaecological procedures. Remaining two female patients had ureteral injuries following ureteroscopy for lower 
ureteral stones. 
Eleven female patients had different symptoms including partial or total incontinence of urine, flank pain, symptoms 
of UTI, high grade fever, sepsis, anuria and urinary leakage. Patients who underwent URS or URS in situ lithotripsy 
had lower ureteral stones. Most of them had lumbar pain, symptoms of UTI, frequency, urgency and difficulty in 
micturation. Two patients had retention of urine for which they were catheterized. One had broken segment of DJ 
stent. Different techniques were employed, ureter re-implantation for distal ureteral injuries was performed  in  ten 
patients. For minor lacerations and suspected urinary leakage following URS for stone disintegration at lower ureter, 
ureteric catheter or DJ stent was placed. 
Conclusion: Iatrogenic uretral injuries are rare following gynaecological, obstetrical and endourological procedures 
but are liable to occur due to inherent anatomic factors. Prompt diagnosis and institution of appropriate corrective 
surgical procedures often result satisfactory outcome.