Management of Ureteric Avulsion During Ureteroscopy: Our Experience in A Case Series

Abstract

Ureterorenoscopy (URS) is usually a safe procedure without any complications. Ureteric avulsion is the most dreaded complication of URS. Most urologists do not have experience in management of ureteric avulsion injuries. Inappropriate management can lead to nephrectomy. Here we are discussing our experience and possible leading factors of this catastrophic complication. We retrospectively reviewed the clinical notes, imaging records, and laboratory investigations of four patients who have been managed for ureteric avulsion in our center during a 12-year period (2008 - 2019). Two cases of lower ureteric avulsion were managed with immediate ureterocystoplasty. Out of which one patient underwent nephroureterectomy. Two cases with total ureteric avulsion were managed with delayed ileal replacement and psoas hitch with Boari flap reconstruction, respectively. During minimum follow-up period of 1 year, no evidence of deterioration in renal function was noted. Use of small caliber scope, proper handling of instruments and minimum forceful manipulation can prevent ureteric avulsion. In experienced hands it can be managed without the requirement of nephrectomy.

World J Nephrol Urol. 2020;9(2):45-51
doi: https://doi.org/10.14740/wjnu417