Interventional radiology in iatrogenic ureteral leaks: case series and literature review

• Published in: Radiologia medica Vol. 122; no. 9; pp. 696 - 704
• Main Authors: Trombatore, Claudia, Giordano, Giuseppe, Magnano San Lio, Vincenzo
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01-09-2017; Springer Nature B.V
• Subjects: Bypasses; Damage; Diagnostic Radiology; Feasibility studies; Healing; Iatrogenesis; Imaging; Injuries; Interventional Radiology; Literature reviews; Medicine; Medicine & Public Health; Neuroradiology; Patients; Pelvis; Percutaneous treatment; Radiology; Surgical implants; Ultrasound; Ureteral stents; Uro-Genital Radiology; Rendez-vous technique; Iatrogenic injuries; Interventional uroradiology
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-017-0774-2

Iatrogenic ureteral injuries are a dramatic complication in medical practice. Nowadays there are no universal guidelines for their management. The aim of our study was to evaluate the feasibility of the percutaneous treatment in restoring ureteral integrity in 19 patients that came to our attention. In each case retrograde stenting failed and patients were candidates for re-surgery. Our strategy consists of two phases. The first step is the nephrostomy that allows an external urinary diversion putting dry the damaged ureteral segment. The second step is the anterograde ureteral double-J stenting that keeps near the two stumps promoting the healing of the injured tract. In complete sections, when both retrograde and anterograde stenting singularly failed, we performed a rendez-vous technique with a combined radiological trans-nephrostomic access and urological cystoscopic approach to realign and catheterize the ureteral stumps. In patients with Bricker urinary diversion, peri-anastomotic leaks were treated by positioning a multi-hole pig-tail catheter with the inner end in the renal pelvis and the distal portion outgoing from the cutaneous stoma. Subsequent pyelographic controls demonstrated the resolution of the ureteral leak in all patients and none required a surgical re-intervention. Nephrostomies were removed and ureteral stents were regularly changed. We conclude that interventional uro-radiology may offer a valid conservative option in iatrogenic urinary injuries.