Diagnostic and interventional radiology management of ureteral iatrogenic leakage after gynecologic surgery

Federico Fontana, Filippo Piacentino, Christian Ossola, Jvan Casarin, Andrea Coppola, Antonella Cromi, Anna Maria Ierardi, Gianpaolo Carrafiello, Antonio Basile, Federico Deho, Fabio Ghezzi, Giulio Carcano, Massimo Venturini

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To report safety and efficacy of interventional radiology procedures in the treatment of gynecologic iatrogenic urinary leaks. Methods: A retrospective analysis of iatrogenic ureteral lesions treated between November 2009 to April 2019 was performed. Under ultrasound (US) and fluoroscopy guidance, an attempt to place a ureteral stent and nephrostomy was carried out in the same session using an anterograde percutaneous approach. At the end of any procedure, a fluoroscopic control and a cone-beam CT scan (CBCT) were performed to check the correct placement and functioning of the nephrostomy and DJ stent. In cases of difficult ureteral stent placement via the single anterograde approach, the collaboration of urologists was requested to perform a rendezvous technique, combined with the retrograde approach. Results: DJ stent placement was achieved using the anterograde approach in 12/15 (80.0%) patients and using the retrograde approach in 3/15 cases (20.0%). Moreover, in 3/15 (20.0%) patients, surgical treatment was needed: in one case because of the persistence of ureteral stenosis at 6 months, and in the other two cases due to ureter-vaginal fistula. No major complications were recorded; overall, minor complications occurred in 4/8 patients. Conclusion: Percutaneous minimally invasive treatment of iatrogenic ureteral lesions after gynecological surgery is a safe and effective option.

Original languageEnglish
Article number750
JournalDiagnostics
Volume11
Issue number5
DOIs
Publication statusPublished - 2021

Keywords

  • Iatrogenic ureteral injuries
  • Interventional uroradiology
  • Ureteral leakage
  • Urinary leak diagnosis

ASJC Scopus subject areas

  • Clinical Biochemistry

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