Organization of urological care for patients with iatrogenic ureteral injury.

OBJECTIVE: Introduction: We conducted a retrospective assessment of diagnostic and therapeutic approaches in patients with iatrogenic ureteral injury, who were treated in a specialized medical center. The aim: The aim of the research was to determine the optimal treatment method for correction of iatrogenic ureteral defects. PATIENTS AND METHODS: Materials and methods: The study included 73 patients with iatrogenic ureteral injury. In 70 cases ureteral reconstruction was carried out with the help of Boari bladder flap. The effectiveness of this approach was assessed retrospectively by analysis of the complications and long-term results of the treatment. RESULTS: Results: The length of the bladder flap varied from 3 to 21 cm and averaged 9.8 ± 1.4 cm. In 6 (8.2%) cases a successful reconstructive surgery of the ureter up to the level of its upper third was performed. The overall frequency of intraoperative complications did not exceed 12.9%. The total frequency of early postoperative complications was high (75.8%), however, they were not severe and required surgical correction only in one (1.4%) case. The total number of positive long-term results (good + satisfactory) amounted to 91.5%. Nephrectomy was required only in 2 (2.3%) cases. CONCLUSION: Conclusions: The Boari bladder flap operation should be considered as the basis of the algorithm for providing medical care to patients with iatrogenic ureteral injury. This type of surgery makes it possible to completely replace the damaged or having doubtful blood supply portion of the ureter even with the defects extending to its upper third. The main advantages of this surgery technique are good blood supply of tubularized bladder flap and a high level of positive long-term results.