Ureteral injuries management in gynaecologic surgery: the role of the conservative approach

Objective . Ureter is one of the most important landmarks to be taken into consideration during gynaecological surgery. Today, mini-invasive techniques are available to treat ureteral injuries in a more conservative way. This study aims to propose a progressive operative model to manage ureteral injuries by comparing conservative and open approaches. Materials and Methods. This retrospective study analysed 27 injuries in 24 patients admitted for ureteral injuries following gynaecological surgery (in 3 cases, ureteral injuries were bilateral). We obtained data from 16 lacerations, 5 stenosis, and 6 fistulas. Patients in the study were treated with three different techniques for ureteral injuries: cystoscopy with retrograde ureteral stenting, interventional radiology and ureterocystoneostomy. Results. In a retrospective analysis for ureteral lacerations, success rates of the various techniques were: 100% ureterocystoneostomy, 67% Rendezvous, 58% percutaneous nephrostomy plus ureteral stenting, 33% Percutaneous Nephrostomy, 33% cystoscopy with ureteral stenting. Considering ureteral stenosis, success rates were: ureterocystoneostomy 100%, percutaneous nephrostomy plus ureteral stent 33%, Rendezvous, Percutaneous Nephrostomy and cystoscopy with ureteral stent 0%. For ureteral fistula, success rates were ureterocystoneostomy 100%, Rendezvous 100%, percutaneous nephrostomy plus ureteral stent 100%, cystoscopy with ureteral stent 33%, Percutaneous Nephrostomy 0%. Conclusions. According to the obtained results, conservative radiologic procedures represent a valid alternative to open surgery. We propose a progressive operative model: interventional radiology represents an effective approach that could postpone or avoid invasive procedures. Ureterocystoneostomy is the procedure with higher success rates.