Management and outcomes of iatrogenic ureteral injuries after ureterorenoscopic stone surgery: A multicenter retrospective analysis

Abstract

INTRODUCTION: Iatrogenic ureteral injuries following ureterorenoscopic (URS) stone surgery are significant complications that can occur despite the preserved structure of the urinary tract. This study aimed to evaluate the demographic characteristics, types of injuries, timing of diagnosis, and outcomes of treatment methods in patients with iatrogenic ureteral injury after URS. MATERIALS AND METHODS: Patients with iatorogenic ureteral injury during URS were included based on retrospective data collected from 19 centers across Turkey between November 2010 and December 2022. Demographics, location, and grade of injury, time of diagnosis, and success rates of endourological or reconstructive surgical interventions were analyzed. Surgical success was defined as the absence of postoperative complications and no need for further surgical intervention. RESULTS: Of the 105 patients, 65 were males and 40 females, with a median age of 48 years (20-86). Injuries occurred in the distal ureter in %60, mid-ureter in %18.1, and proximal ureter in %21.9 of cases. Laceration accounted for %64.7 of the injuries, whereas %35.3 occurred during laser use. Diagnosis was made intraoperatively in %21 and postoperatively in %79 of patients, with a median time to postoperative diagnosis of 30 days (1-720). Higher body mass index was associated with lower primary surgical success (p = 0.049). The most common initial treatment was ureteral stent placement. Reconstructive surgeries had lower rates of secondary interventions or complications compared to endourological procedures (p = 0.045). Among patients necessitating a second surgery, those who underwent reconstructive surgery had significantly lower tertiary intervention or complication rates (p < 0.001). Nephrectomy was required in six patients because of renal atrophy. CONCLUSION: Early diagnosis is crucial in iatrogenic ureteral injuries after URS. Elevated BMI may negatively affect surgical outcomes. Although endourological approaches are commonly used initially, reconstructive surgeries offer more durable outcomes, especially in severe injuries or failed primary treatments, underscoring the need for individualized management strategies.