[Management of ureteral injuries]

Conservative Management of Postoperative Urinary Leak and Intra-Abdominal Abscess

Ureteral injury is a rare occurrence in medical practice. Most cases encountered stem from blunt trauma or are iatrogenic, occurring during open abdominal or pelvic surgery and laparoscopic procedures. Prompt diagnosis of ureteral injury allows clinicians to avoid complications including ureteral strictures, abscess, renal failure, sepsis, and loss of the ipsilateral kidney. Treatment depends on whether the ureteral injury was discovered intraoperatively or if it was a delayed diagnosis. Several procedures can be used, including ureteroureterostomy, ureteroileal interposition, and nephrectomy. Stenting can also be a viable option as it can reestablish urinary drainage. Herein, we present the case of a 43-year-old male who presented with complaints of progressive abdominal pain that was subsequently diagnosed as a left ureteral injury and how the use of a ureteral stent allowed him to have a full recovery with optimized normal ureteral function.

Ureteral avulsion caused by through and through penetrating injury of the pelvis

Ureteral avulsion is one of the rare cases in urology considering that this structure is well-protected in retroperitoneal location. However, the presence of penetrating pelvis injury should raise high clinical suspicion that ureteral avulsion may present in this case. We report the case of ureteral avulsion in patients caused by through and through penetrating injury of the pelvis. We managed ureteral avulsion by performing end-to-end anastomosis along with ureteral stenting. A multidisciplinary approach was performed to treat other structural damages. Finally, after two months, ureteral stent was removed and ileal-re-anastomosis was performed.