Korean J Radiol.  2008 Aug;9(4):348-353. 10.3348/kjr.2008.9.4.348.

Percutaneous Management of Ureteral Injuries that are Diagnosed Late After Cesarean Section

• Ustunsoz B
• Ugurel S
• Duru NK
• Ozgok Y
• Ustunsoz A

• KMID: 1076461
• DOI: http://doi.org/10.3348/kjr.2008.9.4.348

Abstract

OBJECTIVE
We wanted to present the results of percutaneous management of ureteral injuries that were diagnosed late after cesarean sections (CS). MATERIALS AND METHODS: Twenty-two cases with 24 ureteral injuries that were diagnosed late after CS underwent percutaneous nephrostomy (PN), antegrade double J (DJ) catheter placement and balloon dilatation or a combination of these. The time for making the diagnosis was 21 +/- 50.1 days. The injury site was the distal ureter in all cases (the left ureter: 13, the right ureter: 7 and bilateral: 2). Fifteen complete ureteral obstructions were detected in 13 cases. Ureteral leakage due to partial (n = 4) or complete (n = 3) rupture was noted in seven cases. Two cases had ureterovaginal fistula. All the cases were initially confirmed with antegrade pyelography and afterwards they underwent percutaneous nephrostomy. Balloon dilatation was needed in three cases. Antegrade DJ stents were placed in 10 cases, including the three cases with balloon dilatation. Repetititon of percutaneous nephrostomy with balloon dilatation and DJ stent placement was needed in one case with complete obstruction. All the cases were followed-up with US in their first week and then monthly thereafter for up to two years. RESULTS: Eighteen ureters (75%) were managed by percutaneous procedures alone. A total of six ureter injuries had to undergo surgery (25%). CONCLUSION: Percutaneous management is a good alternative for the treatment of post-CS ureteral injuries that are diagnosed late after CS. Percutaneous management is at least preparatory for a quarter of the cases where surgery is unavoidable.

Keyword

Ureter injury; Cesarean section; Percutaneous nephrostomy; Balloon dialatation; Ureteric stent

MeSH Terms

Adult
Balloon Dilatation
Cesarean Section/*adverse effects
Female
Humans
Nephrostomy, Percutaneous
Pregnancy
Rupture
Stents
Time Factors
Ureter/*injuries/surgery
Ureteral Obstruction/diagnosis/etiology

Figure

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  Fig. 1 32-year-old female with ureterovaginal fistula and who presented with vaginal urine leak on first day after cesarean section. A. Antegrade pyelography shows partial transection of lower right ureter with fistulization to genital tract. B. Guidewire passing through injured lower right ureter into bladder. C. Double J catheter is seen in bladder. D. Control antegrade pyelography of case three weeks later shows disappearance of leak.

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