Impact of Injury Mechanism and Diagnostic Pathway on Reconstructive Outcomes Following Iatrogenic Ureteral Injury.

Abstract

Background: Iatrogenic ureteral injury (IUI) is a rare but serious complication of abdominal and pelvic surgery, often leading to substantial morbidity and additional surgical interventions. This study aimed to evaluate the association of the diagnostic pathway (intraoperative diagnosis with immediate repair versus postoperative diagnosis with delayed repair) with perioperative and functional outcomes.

Methods: In this study, 92 patients who underwent reconstructive surgery for IUI between 2015 and 2025 were retrospectively analyzed. The patients were stratified into early and delayed repair groups, and injuries were classified as thermal full-thickness injury, thermal ischemic injury, or non-thermal full-thickness injury. Perioperative, postoperative, and functional outcomes were compared.

Results: Of the 92 patients, 62 (67.4%) underwent early repair and 30 (32.6%) delayed repair. Delayed repair was associated with a longer hospital stay [9 (7-12.5) vs. 7 (5-7) days; p = 0.004], higher rates of percutaneous nephrostomy (83.3% vs. 0%; p < 0.001), and reoperation (16.7% vs. 0%; p = 0.003). Overall complication, nephrectomy, hydronephrosis, and long-term renal functional loss rates were comparable between groups. Thermal ischemic injury was associated with significantly higher postoperative complication rates than thermal full-thickness and non-thermal full-thickness injuries (53.3% vs. 25.0% vs. 23.1%, respectively; p = 0.021).

Conclusions: A delayed diagnostic pathway, resulting in delayed reconstruction, was associated with prolonged hospitalization, greater need for urinary diversion, and higher reoperation rates. Thermal ischemic strictures represented a distinct subgroup with an increased risk of postoperative complications. These findings highlight the importance of early recognition and appropriate reconstructive management in patients with IUI.