TREATMENT PLANS AND RESULTS IN IATROGENIC URETERAL INJURIES

We treated 19 patients with iatrogenic ureteral injuries during a 10- year period. Gynecologiacal operations were the most common surgical procedures (52.6%). The diagnosis of ureteral injury was made immediately in 6 patients and was delayed 14 to 180 days in 13. Five of the 6 injuries recognized during the operation were repaired successfully at the time of injury; one patient resulted a nephrectomy. Seven of the lately recognized 13 patients were treated with percutaneous nephrostomy and the first treatment. The two patients were made ureteroneocystostomy, one was made ureteroureterostomy and one had ureterolysis in the other five patients. We observed ureteral stenosis in the three patients after the operation follow ups. The treatment was achieved with the endourological approach at these patients. Finally, we recommend percutaneous nephrostomy as a first treatment choice in the lately recognized iatrogenic ureteral injuries, while the immediate diagnosis and treatment of iatrogenic üreteral injuries, are severely important.

ÝATROJENÝK ÜRETERAL TRAVMALARDA TEDAVÝ PLANLARIMIZ VE SONUÇLARI

10 yýllýk bir periyot içerisinde 19 iatrojenik üreler travmalý olgunun tedavisi yapýldý. Jinekolojik operasyonlar %52.6 ile en sýk 1 travmaya neden olan cerrahi giriþimlerdi. Altý olgunun teþhisi operasyon anýnda, 13 olgunun teþhisi ise operasyondan sonra 14-180. günler arasýnda konuldu. Operasyon sýrasýnda üreler travmasý belirlenen 6 olgunun 5'i baþarýlý bir þekilde tedavi edilirken 1 olguya nefrektomi yapýldý. Geç taný konulan 13 olgunun 7'sine perkütan nefrostomi ile baþlangýç tedavisi yapýldý. Diðer 5 olgunun 2'sine üreteroneosistostomi, 1'ine üreteroüreterostomi ve 1'ine ise üreterolizis yapýldý. Üç olguda operasyon sonrasý takiplerde üreteral darlýk belirledik. Bu olgularda endoürolojik yaklaþým ile tedavi saðlandý. Sonuçta iatrojenik üreter travmalarýnýn operasyon anýnda tanýsý ve tedavisi önemliyken, geç dönemde taný konulan iyatrojenik üreteral travmalý olgularda ilk tedavi seçeneði olarak perkütan nefrostomi önermekteyiz.