Comment on renal autotransplantation: A final option to preserve the kidney after an iatrogenic ureteral injury

To the Editor, Autologous Renal Transplantation (ART) since firstly described in 1963 by Hardy, has been used in various cases. There are various reasons for the transplantation such as iatrogenic ureteral damage, chronic kidney pain, unresectable renal tumors or renovascular diseases. Indications concerning the suitable patients for this kind of procedure are gradually increasing. Nevertheless, each case is unique, and the treatment must be personalized [...].

Case Report: Early Recognition and Repair of Distal Iatrogenic Ureteral Injury During Laparoscopic Rectal Surgery

Background: Ureteral injury is an uncommon complication of the colorectal procedure. The colorectal procedure is the second most common cause of ureteral injury. The laparoscopic approach for colorectal surgery has contributed to the increase of ureteral injury. Delayed diagnosis of the iatrogenic ureteral injury is associated with higher morbidity. However, the early diagnosis of ureteral injury during the operation is difficult. We presented an early recognition and laparoscopic repair of iatrogenic ureteral injury during laparoscopic rectal cancer surgery cases and the strategy for recognizing and managing that injury for the surgeon.Case Presentation: A Male, 34 years old, had an iatrogenic ureteral injury during laparoscopic low anterior resection for rectal cancer. The left distal ureter was transected by an energy device. The diagnosis of ureteral injury was prompt. The repair of the ureter was done endo-laparoscopically. The patient had an uneventful recovery and was discharged on day 6 after surgery.Conclusion: The iatrogenic ureteral injury, although uncommon, is a serious complication of laparoscopic colorectal surgery. Direct visual identification of the distal ureter is mandatory in every rectal surgery. The iatrogenic ureteral injury is not an indication for open conversion when there is an adequate resource to do the endo-laparoscopic ureteral repair.

Diagnosis and management of iatrogenic ureteral injury in total laparoscopic hysterectomy

Ureteral injury is common in gynecological surgeries due to the proximity to organs. The risk of ureteral injury is higher in laparoscopic hysterectomy operations compared to abdominal or vaginal hysterectomies. Obesity, endometriosis, pelvic adhesions, history of previous surgery, enlarged uterus, and intraoperative hemorrhage are some of the risk factors identified for ureteral injury. Intraoperative cystoscopy and postoperative urinary ultrasonography can be used in the diagnosis of early ureteral injury. Management of ureteral injury differs according to the extent, type, and localization of the injury. In evaluating the ureteral injury, early diagnosis and early repair in appropriate patients are essential in morbidity and medicolegal.

Does Endourological Intervention a Suitable Treatment Options in Management of Iatrogenic Thermal Ureteral Injury?

Introduction This study aimed to evaluate the etiological factors and their effects on long-term clinical outcomes in patients with iatrogenic ureteral injury (IUI). Material and Method Twenty-seven patients who underwent surgery because of IUI were evaluated between January 2011 and April 2018. Patients were classified according to the time of diagnosis and the need for reoperation after the urologic intervention. The IUI cases detected during gynecological surgery were called ‘perioperative’ IUI, and those diagnosed late as ‘postoperative’ (delayed) IUI. The IUI type was categorized as ‘cold transection’ due to surgical dissection or ligation and ‘thermal injury’ if it depended on any energy-based surgical device. Results Postoperative diagnosed cases consisted of exclusively after laparoscopic surgery (p=.025). Patients with thermal injury to the ureter were mostly diagnosed postoperatively (p= .021). Patients who underwent endourological intervention, 31.25% (N = 5/16) were diagnosed during gynecologic surgery, and 68.75% (n = 11/16) were diagnosed postoperatively. For open reconstructive surgery, these rates were observed to be 72.72% (n = 8/11) and 27.28% (n = 3/11), respectively (p=.034). IUI was due to thermal injury in all patients who developed complications after the urological intervention (p = .046), and the first urological intervention was endoscopic double loop stenting (p = .005). One of these patients was diagnosed in the perioperative period and seven in the postoperatively (p = .016). Conclusion Treatment success rates are low in patients who underwent endourological intervention after thermal IUI. Therefore, surgical techniques in which the traumatic ureter segment is excised should be preferred to avoid complications. Key Words Ureter, Iatrogenic, Thermal Injury, Iatrogenic Ureteral Injury, Endourological Intervention.