Endoscopic ureteric realignment with tandem stents: An endoluminal approach to managing ureteric injuries
BAUS ePoster online library. Matanhelia M. Jun 26, 2019; 259499; P13-5
Mudit Matanhelia
Mudit Matanhelia
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Abstract
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INTRODUCTION

Ureteric injuries are a recognised complication of abdominal surgery. Further surgery to repair the defect increases fistulation risk and morbidity. Endoscopic ureteric realignment (EUR) with tandem stents averts the need for invasive surgery. Our results are discussed here.

METHODS

Patients with iatrogenic ureteric injury who underwent ureteric re-alignment were included.

EUR was enabled with the patient positioned in modified 45° lithotomy, enabling antegrade interventional radiology access and retrograde semi-rigid ureteroscopy.

Laser stricturotomy was undertaken with 3-D fluoroscopic review if required. Ureteric stricture balloon dilatation was performed, with insertion of tandem 6Fr. stents. Further ureteroscopy was done at 3 months, with ureteric dilatation if necessary, before a decision to remove stents.

RESULTS

Over a 6 year period, 28 patients underwent EUR, with 3 patients having proximal and 25 with distal ureteric strictures or transections. Average age was 61 years (20 – 93 years). Average follow-up was 16 months (1 – 67 months).

EUR was enabled in 26 patients; with 14 (54%) patients stent free. Antegrade realignment was feasible in those with ureteric orifice injuries.

Patients who were stent dependent had a colorectal associated injury, pelvic radiotherapy, or proximal ureteric injuries.

CONCLUSION

EUR has a 93% success rate with 54% stent free. Patients had a return to normal calibre ureter with an open scar at the site of injury; attributable to tandem stents enabling 'remodelling on scaffolding'. These long-term results suggest that EUR should be the first step in managing ureteric injuries, especially in patients with 'clean' (non-colorectal) injuries.
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