Iatrogenic ureteral injuries: analysis of etiology, clinical features, and outcomes of reconstructive treatment (experience of a specialized center)
Introduction. Iatrogenic ureteral injuries represent a significant problem in urology and occur predominantly during surgical procedures in the pelvis and abdominal cavity performed for gynecological, urological, and other conditions, leading to serious complications, including impaired renal function and reduced quality of life. With the increasing use of minimally invasive procedures, the incidence of iatrogenic ureteral injuries is rising. A critical challenge is the difficulty of intraoperative diagnosis, which results in delayed detection of injuries and more severe consequences.Usupbaev A.Ch., Toktosopiev Ch.N., Usmanov A.M., Rysbaev B.A., Kurbanaliev R.M., Stambekova K.N., Oskon uulu A., Nogoibaeva K.A.
Aim. To investigate the etiology, clinical characteristics, and treatment efficiency of iatrogenic ureteral injuries.
Materials and methods. A retrospective and prospective study of 141 patients with diagnosed iatrogenic ureteral injuries was carried out at the Urology Research Center of the National Hospital of the Ministry of Health of the Kyrgyz Republic from 2010 to 2024. Diagnosis was based on analysis of clinical manifestations (pain, fever, vaginal urine leakage) and instrumental methods (ultrasound, contrast-enhanced CT, pyelography). Injuries were classified according to the AAST (American Association for the Surgery of Trauma) scale. Treatment efficiency was assessed using clinical and radiological outcomes during 1 year after surgery. Statistical analysis was performed using SPSS 24.0.
Results. Women predominated (87.2%); the median age was 38 years. The main causes of injury in women were surgeries for gynecological diseases (72.3%), whereas in men injuries were mainly related to urological interventions (88.9%). In 92.2% of cases, injuries were located in the distal ureter. AAST grade II injuries predominated (53.2%). Intraoperatively, injury was identified in only 7.1% of cases; most cases (82.3%) were diagnosed postoperatively. Ureterovaginal fistulas occurred in 23.4% of women. Reconstructive surgery (predominantly ureteroneocystostomy, 68.1%) was required in 69.5% of patients. Nephrectomy was performed in 12 patients (8.5%), mainly as a consequence of very late diagnosis. Complete clinical efficiency of reconstruction was achieved in 87.2% of patients, with preservation of renal function in the long term.
Discussion. The analysis confirms that the majority of iatrogenic ureteral injuries occur during gynecological surgery and are localized to the distal ureter. In men, injuries related to endourological interventions predominate, including procedures using the Ho:YAG laser. The main factor associated with worse outcomes was delayed diagnosis, which led to an increased number of repeat procedures and a higher rate of complications, particularly fistulas and strictures. The predominance of AAST grade II–III injuries resulted in the need for reconstructive interventions in most patients, most commonly ureteroneocystostomy and Boari flap reconstruction. Despite the severity of complications, reconstructive surgery demonstrates high effectiveness. The identified tactical principles include early detection, active use of instrumental diagnostics, drainage in cases of delayed diagnosis, and an individualized choice of reconstructive technique.
Conclusion. The study showed that iatrogenic ureteral injuries in Kyrgyzstan most often occur after obstetric and gynecological surgical procedures and involve the distal ureter. Unfavorable outcomes are mainly associated with chronic kidney disease, prior radiotherapy, and late detection. In the absence of these factors, reconstructive procedures, including ureteroneocystostomy, allow preservation of renal function in the long term. Improving intraoperative diagnosis and standardizing management approaches remain key priorities to increase treatment efficiency.
Keywords
iatrogenic ureteral injury
ureteroneocystostomy
reconstructive surgery
minimally invasive methods
About the Authors
Corresponding author: Rysbaev Bakyt Asanovich – Ph.D., Associate Professor, Department of “Urology and Andrology of Pre- and Postgraduate Education named after M.T. Tynaliev”, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyz Republic; e-mail: brysbaev@gmail.comSimilar Articles
