Iatrogenic ureteral injury: Can adult repair techniques be used on children?

Jonathan C. Routh, Matthew K. Tollefson, Richard A. Ashley, Douglas A. Husmann

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: Iatrogenic ureteral injury in children is a rare occurrence, with sparse literature available regarding optimal repair techniques. We reviewed our experience in the management of iatrogenic pediatric ureteral injuries, particularly with respect to initial versus delayed diagnoses. Methods: All pediatric iatrogenic ureteral injuries repaired by a single surgeon during 1986-2007 were reviewed. Results: Ten injuries were repaired over 20 years. Median patient age was 12 years. Injuries occurred during five open tumor resections, three laparoscopic procedures and two ureteroscopies. Diagnosis was immediate in four patients. Median ureteral defect length was 4 cm (range 2-5). All underwent ureteral reimplantation and psoas hitch Boari flap. Median follow up was 1 year, with no obstruction noted. Diagnosis was delayed in six patients by a median of 21 days. Five children (83%) were managed by temporary percutaneous nephrostomy tube and one (17%) by ureteral stent. Delayed repair was performed 1-3 months later. In the patients with laparoscopic or ureteroscopic injuries the median ureteral defect length was 4 cm (range 3-6). All underwent ureteral reimplantation and psoas hitch Boari flap. Median follow up was 1 year, with no obstruction noted. One child had a proximal ureteral defect 8 cm long; delayed ileal ureter was performed with good results 4 years postoperatively. Conclusions: Pediatric iatrogenic ureteral injuries are rare and may be repaired by both immediate and delayed techniques as circumstances demand. Standard techniques used in the adult population may be employed in children with the expectation of good long-term results.

Original languageEnglish (US)
Pages (from-to)53-55
Number of pages3
JournalJournal of Pediatric Urology
Volume5
Issue number1
DOIs
StatePublished - Feb 2009

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Wounds and Injuries
Replantation
Delayed Diagnosis
Pediatrics
Ureteroscopy
Percutaneous Nephrostomy
Ureter
Stents
Population
Neoplasms

Keywords

  • Injury
  • Pediatric
  • Postoperative complications
  • Ureter

ASJC Scopus subject areas

  • Urology
  • Pediatrics, Perinatology, and Child Health

Cite this

Iatrogenic ureteral injury : Can adult repair techniques be used on children? / Routh, Jonathan C.; Tollefson, Matthew K.; Ashley, Richard A.; Husmann, Douglas A.

In: Journal of Pediatric Urology, Vol. 5, No. 1, 02.2009, p. 53-55.

Research output: Contribution to journalArticle

Routh, Jonathan C. ; Tollefson, Matthew K. ; Ashley, Richard A. ; Husmann, Douglas A. / Iatrogenic ureteral injury : Can adult repair techniques be used on children?. In: Journal of Pediatric Urology. 2009 ; Vol. 5, No. 1. pp. 53-55.
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abstract = "Objective: Iatrogenic ureteral injury in children is a rare occurrence, with sparse literature available regarding optimal repair techniques. We reviewed our experience in the management of iatrogenic pediatric ureteral injuries, particularly with respect to initial versus delayed diagnoses. Methods: All pediatric iatrogenic ureteral injuries repaired by a single surgeon during 1986-2007 were reviewed. Results: Ten injuries were repaired over 20 years. Median patient age was 12 years. Injuries occurred during five open tumor resections, three laparoscopic procedures and two ureteroscopies. Diagnosis was immediate in four patients. Median ureteral defect length was 4 cm (range 2-5). All underwent ureteral reimplantation and psoas hitch Boari flap. Median follow up was 1 year, with no obstruction noted. Diagnosis was delayed in six patients by a median of 21 days. Five children (83{\%}) were managed by temporary percutaneous nephrostomy tube and one (17{\%}) by ureteral stent. Delayed repair was performed 1-3 months later. In the patients with laparoscopic or ureteroscopic injuries the median ureteral defect length was 4 cm (range 3-6). All underwent ureteral reimplantation and psoas hitch Boari flap. Median follow up was 1 year, with no obstruction noted. One child had a proximal ureteral defect 8 cm long; delayed ileal ureter was performed with good results 4 years postoperatively. Conclusions: Pediatric iatrogenic ureteral injuries are rare and may be repaired by both immediate and delayed techniques as circumstances demand. Standard techniques used in the adult population may be employed in children with the expectation of good long-term results.",
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