Ureteral injury repair

Authors: A.Rossetti, O.Sizzi

Ureteral injury is one of the possible complications of endometriosis surgery.
Ureteral dissection can cause a mechanical and sometimes a thermal damage to the ureteral wall.

The thermal injury is usually the worst scenario: the lesion can in fact lead not only to a direct burning of the ureter but, most of the time, to an ischemic damage of the vascular bundle that envelops the ureter with consequent necrosis of the ureteral wall. This video shows the case of a young patient who underwent an operation for deep infiltrating endometriosis made in another hospital. The surgeon used the laser for the dissection of the extensive adhesions of the deep infiltrating endometriosis at the level of the posterior leaf of the broad ligament.

In the first postoperative day, the patient conditions worsened presenting abdominal pain, a little increase in CRP, an increase in creatinine levels. Because of no improvement in the patient conditions, it was decided to refer the patient and we decided to perform an emergency diagnostic laparoscopy. We found filmy adhesions that were removed by blunt dissection. There was no sign of infection because urine is sterile. There was free urine in the pelvis and the dissection pointed out the leakage of urine from a hole in the right ureteral wall.

Thereafter a cystoscopy was performed and a double J ureteral stent was inserted. After the removal of some necrotic debris from the ureteral wall, a single 4-0 Monocryl suture was applied to close the hole. A drainage was left inside the pelvis and was removed in day fourth.
The post-operative period was uneventful and the double J stent was removed after 60 days.