World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Nephrol Urol and Elmer Press Inc
Journal website https://www.wjnu.org

Case Report

Volume 9, Number 2, December 2020, pages 45-51

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

Figures

Figure 1.
Figure 1. (a) Plain CT KUB (coronal view) showing left upper ureteric injury and residual stone fragments in left pelvicalyceal system. (b) Axial view showing left perinephric urinoma. CT KUB: computed tomography of kidney, ureter and bladder.
Figure 2.
Figure 2. (a, b) Proximal site of anastomosis between renal pelvis and ileum. (c) Ileum anastomosed to anterior bladder wall.
Figure 3.
Figure 3. (a) Avulsed ureter tightly gripped over 8/9.8Fr ureteroscope. (b) Nephrostogram showing proximal intact ureter. (c) Looped proximal intact ureter and distended bladder after ligating contralateral superior vesical pedicle.
Figure 4.
Figure 4. (a) Defect length of about 12 cm measured intraoperatively between ureter and the bladder. (b) Anterior bladder wall flap raised to reconstruct the ureter. (c) Proximal ureter anastomosed to the side of bladder wall flap. (d) Boari flap reconstruction of ureter.

Table

Table 1. Patients Characteristics, Management and Follow-up Details
 
Case1234
PUJ: pelviureteric junction; PCN: percutaneous nephrostomy.
Age (years)48555360
SexFemaleFemaleFemaleMale
ComorbiditiesDiabetesDiabetesNoDiabetes and hypertension
Size and location of stone11 mm impacted lower ureteric stone6 mm mid ureteric stone9 mm upper ureteric stone8 mm impacted mid ureteric stone
Size of ureteroscope8/9.8Fr semirigid8/9.8Fr semirigidNot known8/9.8Fr semirigid
SideLeftRightLeftRight
Site of avulsionLower ureterLower ureterPUJUpper ureter
Length of residual ureter20 cm15 cmNot known5 - 6 cm
Intervention timeImmediateImmediatePCN insertion after 3 daysImmediate PCN insertion
Reconstruction after 6 weeksReconstruction after 6 weeks
OperationUreterocystoplasty + psoas hitchUreterocystoplasty + psoas hitchIntestinal interpositionBoari flap + psoas hitch
Follow-up (years)1281.51
ComplicationsNone. Adequate parenchymal thickness.Required nephrectomy for pyonephrosis and non-functioning kidney.Mild hydronephrosis with adequate parenchymal thickness.Mild urgency and frequency.