Endoscopic treatment of intraluminal ureteral suture with holmium laser

Although reconstructive surgery is the most accepted treatment for ureteral injury, there are reports of cases where endourologic treatment led to correct resolution of the problem. We present the case of a female patient aged 72-year-old who was previously underwent sacralcolpopexy because of anterior vaginal compartment prolapse. The patient underwent surgery to remove the mesh, due to the pain she had had since it was placed. A mid-line laparotomy was performed removing completely the mesh. At 48 hours after intervention, the patient started feeling an intense pain in the left renal fossa that was not relieved with anti-inflammatories and morphic drugs. In the diagnostic ureteroscopy, it was found iatrogenic suture of the ureter. Due to the availability of holmium laser, an endoureterotomy was performed in the 12h central position on the tip, with laser parameters of 1J-10Hz. A 6F ureteral stent was maintained for one month. During follow-up, the patient remained asymptomatic and without dilation of the left system on imaging tests. Although we accept that open reconstruction is the gold standard treatment for ureteral trauma, we describe holmium laser endoureterotomy as a promising technique to consider in the event of ureteral intraluminal ligation.

FIVE YEARS CHARACTERISTIC OF URETERAL TRAUMA IN TERTIARY HOSPITAL IN WEST JAVA FROM 2013-2017

Objective: This study aims to determine the characteristics of trauma patients, especially ureteral trauma in Hasan Sadikin General Hospital and expected to be used as data for trauma nationally. Material & Methods: This study was descriptive. Retrospective data collection is taken from medical records of ureteral trauma from 2013 until August 2017 at Hasan Sadikin General Hospital, Bandung. The data obtained are gender, mechanism of trauma, and management of ureteral trauma. Results: A total of 20489 cases of trauma handled in Hasan Sadikin General Hospital, 2.3% is a case of urogenital trauma and 40 of which are cases of ureteral trauma (0.19%). Most ureteral trauma patients are female (90%). Based on the trauma mechanism, 39 patients iatrogenic trauma (97.5%) and 1 patient gunshot wounds (2.5%). From iatrogenic ureteral trauma, 36 patients (90%) had iatrogenic trauma from the gynecological procedure, 5% as a result of the urological procedure, and 2.5% due to gastrointestinal procedure. Management of ureteral trauma is 47.5% ureteroureterostomy and 25% ureteroneocystostomy. Conclusion: Most cases of ureteral trauma are experienced by women, and most commonly due to iatrogenic trauma. Iatrogenic ureteral trauma caused by gynecology procedure is the most common.