Download PDF
Semin intervent Radiol 2015; 32(02): 195-208
DOI: 10.1055/s-0035-1549378
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Iatrogenic Urinary Tract Injuries: Etiology, Diagnosis, and Management

Anthony M. Esparaz
1   Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Jeffrey A. Pearl
2   Department of Urology, Emory University, Atlanta, Georgia
,
Brian R. Herts
3   Department of Abdominal Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
,
Justin LeBlanc
4   Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
,
Baljendra Kapoor
5   Department of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

Publication Date:
28 May 2015 (online)

Also available at
    Permissions and Reprints

Abstract

Iatrogenic injury to the urinary tract, including the kidneys, ureters, bladder, and urethra, is a potential complication of surgical procedures performed in or around the retroperitoneal abdominal space or pelvis. While both diagnostic and interventional radiologists often play a central and decisive role in the identification and initial management of a variety of iatrogenic injuries, discussions of these injuries are often directed toward specialists such as urologists, obstetricians, gynecologists, and general surgeons whose procedures are most often implicated in iatrogenic urinary tract injuries. Interventional radiologic procedures can also be a source of an iatrogenic urinary tract injury. This review describes the clinical presentation, risk factors, imaging findings, and management of iatrogenic renal vascular and urinary tract injuries, as well as the radiologist's role in the diagnosis, treatment, and cause of these injuries.

Keywords

iatrogenic injury - renal vascular - ureter - bladder - interventional radiology
 

  • References

  • 1 Selzman AA, Spirnak JP. Iatrogenic ureteral injuries: a 20-year experience in treating 165 injuries. J Urol 1996; 155 (3) 878-881
    CrossrefPubMedGoogle Scholar
  • 2 Hairston JC, Ghoniem GM. Urinary tract injuries: recognition and management. Clin Colon Rectal Surg 2003; 16: 27-38
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Delacroix Jr SE, Winters JC. Urinary tract injuries: recognition and management. Clin Colon Rectal Surg 2010; 23 (3) 104-112
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Summerton DJ, Kitrey ND, Lumen N, Serafetinidis E, Djakovic N ; European Association of Urology. EAU guidelines on iatrogenic trauma. Eur Urol 2012; 62 (4) 628-639
    CrossrefPubMedGoogle Scholar
  • 5 Brandes S, Coburn M, Armenakas N, McAninch J. Diagnosis and management of ureteric injury: an evidence-based analysis. BJU Int 2004; 94 (3) 277-289
    CrossrefPubMedGoogle Scholar
  • 6 Ustunsoz B, Ugurel S, Duru NK, Ozgok Y, Ustunsoz A. Percutaneous management of ureteral injuries that are diagnosed late after cesarean section. Korean J Radiol 2008; 9 (4) 348-353
    CrossrefPubMedGoogle Scholar
  • 7 Preston JM. Iatrogenic ureteric injury: common medicolegal pitfalls. BJU Int 2000; 86 (3) 313-317
    CrossrefPubMedGoogle Scholar
  • 8 Kapoor BS, Esparaz A, Levitin A, McLennan G, Moon E, Sands M. Nonvascular and portal vein applications of cone-beam computed tomography: current status. Tech Vasc Interv Radiol 2013; 16 (3) 150-160
    CrossrefPubMedGoogle Scholar
  • 9 Abboudi H, Ahmed K, Royle J, Khan MS, Dasgupta P, N'Dow J. Ureteric injury: a challenging condition to diagnose and manage. Nat Rev Urol 2013; 10 (2) 108-115
    CrossrefPubMedGoogle Scholar
  • 10 Gomez RG, Ceballos L, Coburn M , et al. Consensus statement on bladder injuries. BJU Int 2004; 94 (1) 27-32
    CrossrefPubMedGoogle Scholar
  • 11 Armenakas NA, Pareek G, Fracchia JA. Iatrogenic bladder perforations: longterm followup of 65 patients. J Am Coll Surg 2004; 198 (1) 78-82
    CrossrefPubMedGoogle Scholar
  • 12 Hausegger KA, Portugaller HR. Percutaneous nephrostomy and antegrade ureteral stenting: technique-indications-complications. Eur Radiol 2006; 16 (9) 2016-2030
    CrossrefPubMedGoogle Scholar
  • 13 Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol 2007; 51 (4) 899-906 , discussion 906
    CrossrefPubMedGoogle Scholar
  • 14 Ramchandani P, Cardella JF, Grassi CJ , et al; Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for percutaneous nephrostomy. J Vasc Interv Radiol 2003; 14 (9, Pt 2) S277-S281
    PubMedGoogle Scholar
  • 15 Tan TJ, Teh HS, Pua U, Ho SH. Endovascular management of iatrogenic renal vascular injuries complicating percutaneous nephrolithotripsy: role of renal angiography and superselective coil embolisation. J HK Coll Radiol 2008; 11: 103-107
    PubMedGoogle Scholar
  • 16 Turna B, Nazli O, Demiryoguran S, Mammadov R, Cal C. Percutaneous nephrolithotomy: variables that influence hemorrhage. Urology 2007; 69 (4) 603-607
    CrossrefPubMedGoogle Scholar
  • 17 Ierardi AM, Floridi C, Fontana F , et al. Transcatheter embolisation of iatrogenic renal vascular injuries. Radiol Med (Torino) 2014; 119 (4) 261-268
    CrossrefPubMedGoogle Scholar
  • 18 El-Nahas AR, Shokeir AA, El-Assmy AM , et al. Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol 2007; 177 (2) 576-579
    CrossrefPubMedGoogle Scholar
  • 19 Lewis S, Patel U. Major complications after percutaneous nephrostomy-lessons from a department audit. Clin Radiol 2004; 59 (2) 171-179
    CrossrefPubMedGoogle Scholar
  • 20 Phadke RV, Sawlani V, Rastogi H , et al. Iatrogenic renal vascular injuries and their radiological management. Clin Radiol 1997; 52 (2) 119-123
    CrossrefPubMedGoogle Scholar
  • 21 Srivastava A, Singh KJ, Suri A , et al. Vascular complications after percutaneous nephrolithotomy: are there any predictive factors?. Urology 2005; 66 (1) 38-40
    CrossrefPubMedGoogle Scholar
  • 22 Vignali C, Lonzi S, Bargellini I , et al. Vascular injuries after percutaneous renal procedures: treatment by transcatheter embolization. Eur Radiol 2004; 14 (4) 723-729
    CrossrefPubMedGoogle Scholar
  • 23 Kluner C, Rogalla P, Gralla O, Elgeti T, Hamm B, Kroencke T. Value of dual-phase multislice CT prior to minimally invasive therapy of iatrogenic renal injuries. J Endovasc Ther 2005; 12 (4) 461-468
    CrossrefPubMedGoogle Scholar
  • 24 Sam K, Gahide G, Soulez G , et al. Percutaneous embolization of iatrogenic arterial kidney injuries: safety, efficacy, and impact on blood pressure and renal function. J Vasc Interv Radiol 2011; 22 (11) 1563-1568
    CrossrefPubMedGoogle Scholar
  • 25 Ueda J, Furukawa T, Takahashi S, Miyake O, Itatani H, Araki Y. Arterial embolization to control renal hemorrhage in patients with percutaneous nephrostomy. Abdom Imaging 1996; 21 (4) 361-363
    CrossrefPubMedGoogle Scholar
  • 26 Chatziioannou A, Brountzos E, Primetis E , et al. Effects of superselective embolization for renal vascular injuries on renal parenchyma and function. Eur J Vasc Endovasc Surg 2004; 28 (2) 201-206
    CrossrefPubMedGoogle Scholar
  • 27 Zeng G, Zhao Z, Wan S , et al. Failure of initial renal arterial embolization for severe post-percutaneous nephrolithotomy hemorrhage: a multicenter study of risk factors. J Urol 2013; 190 (6) 2133-2138
    CrossrefPubMedGoogle Scholar
  • 28 Léonard F, Fotso A, Borghese B, Chopin N, Foulot H, Chapron C. Ureteral complications from laparoscopic hysterectomy indicated for benign uterine pathologies: a 13-year experience in a continuous series of 1300 patients. Hum Reprod 2007; 22 (7) 2006-2011
    CrossrefPubMedGoogle Scholar
  • 29 Kalisvaart JF, Finley DS, Ornstein DK. Robotic-assisted repair of iatrogenic ureteral ligation following robotic-assisted hysterectomy. JSLS 2008; 12 (4) 414-416
    PubMedGoogle Scholar
  • 30 Ostrzenski A, Radolinski B, Ostrzenska KM. A review of laparoscopic ureteral injury in pelvic surgery. Obstet Gynecol Surv 2003; 58 (12) 794-799
    CrossrefPubMedGoogle Scholar
  • 31 Akin Y, Basara I, Bozkurt A. Minimally invasive treatment of iatrogenic complete left ureter obstruction after hysterectomy. J Health Sci 2012; 2: 144-147
    PubMedGoogle Scholar
  • 32 Nolte-Ernsting C, Cowan N. Understanding multislice CT urography techniques: Many roads lead to Rome. Eur Radiol 2006; 16 (12) 2670-2686
    CrossrefPubMedGoogle Scholar
  • 33 Van Der Molen AJ, Cowan NC, Mueller-Lisse UG, Nolte-Ernsting CC, Takahashi S, Cohan RH ; CT Urography Working Group of the European Society of Urogenital Radiology (ESUR). CT urography: definition, indications and techniques. A guideline for clinical practice. Eur Radiol 2008; 18 (1) 4-17
    CrossrefPubMedGoogle Scholar
  • 34 LaFontaine P. Management of ureteral injury. Oper Tech Gen Surg 2007; 9: 167-174
    CrossrefPubMedGoogle Scholar
  • 35 De Cicco C, Ret Dávalos ML, Van Cleynenbreugel B, Verguts J, Koninckx PR. Iatrogenic ureteral lesions and repair: a review for gynecologists. J Minim Invasive Gynecol 2007; 14 (4) 428-435
    CrossrefPubMedGoogle Scholar
  • 36 Ku JH, Kim ME, Jeon YS, Lee NK, Park YH. Minimally invasive management of ureteral injuries recognized late after obstetric and gynaecologic surgery. Injury 2003; 34 (7) 480-483
    CrossrefPubMedGoogle Scholar
  • 37 Lask D, Abarbanel J, Luttwak Z, Manes A, Mukamel E. Changing trends in the management of iatrogenic ureteral injuries. J Urol 1995; 154 (5) 1693-1695
    CrossrefPubMedGoogle Scholar
  • 38 Balbay MD, Cimentepe E, Unsal A, Bayrak O, Koç A, Akbulut Z. The actual incidence of bladder perforation following transurethral bladder surgery. J Urol 2005; 174 (6) 2260-2262 , discussion 2262–2263
    CrossrefPubMedGoogle Scholar
  • 39 Teerapong S, Rungaramsin P, Tanprasertkul C, Bhamarapravatana K, Suwannarurk K. Major complication of gynaecological laparoscopy in Police General Hospital: a 4-year experience. J Med Assoc Thai 2012; 95 (11) 1378-1383
    PubMedGoogle Scholar
  • 40 Lee JS, Choe JH, Lee HS, Seo JT. Urologic complications following obstetric and gynecologic surgery. Korean J Urol 2012; 53 (11) 795-799
    CrossrefPubMedGoogle Scholar
  • 41 McGeady JB, Breyer BN. Current epidemiology of genitourinary trauma. Urol Clin North Am 2013; 40 (3) 323-334
    CrossrefPubMedGoogle Scholar
  • 42 Cordon BH, Fracchia JA, Armenakas NA. Iatrogenic nonendoscopic bladder injuries over 24 years: 127 cases at a single institution. Urology 2014; 84 (1) 222-226
    CrossrefPubMedGoogle Scholar
  • 43 Adelman MR, Bardsley TR, Sharp HT. Urinary tract injuries in laparoscopic hysterectomy: a systematic review. J Minim Invasive Gynecol 2014; 21 (4) 558-566
    CrossrefPubMedGoogle Scholar
  • 44 Mendez LE. Iatrogenic injuries in gynecologic cancer surgery. Surg Clin North Am 2001; 81 (4) 897-923
    CrossrefPubMedGoogle Scholar
  • 45 Traxer O, Pasqui F, Gattegno B, Pearle MS. Technique and complications of transurethral surgery for bladder tumours. BJU Int 2004; 94 (4) 492-496
    CrossrefPubMedGoogle Scholar
  • 46 Carroll PR, McAninch JW. Major bladder trauma: the accuracy of cystography. J Urol 1983; 130 (5) 887-888
    PubMedGoogle Scholar
  • 47 Morey AF, Hernandez J, McAninch JW. Reconstructive surgery for trauma of the lower urinary tract. Urol Clin North Am 1999; 26 (1) 49-60 , viii
    CrossrefPubMedGoogle Scholar
  • 48 Tulikangas PK, Weber AM, Larive AB, Walters MD. Intraoperative cystoscopy in conjunction with anti-incontinence surgery. Obstet Gynecol 2000; 95 (6, Pt 1) 794-796
    CrossrefPubMedGoogle Scholar
  • 49 Nezhat CH, Seidman DS, Nezhat F, Rottenberg H, Nezhat C. Laparoscopic management of intentional and unintentional cystotomy. J Urol 1996; 156 (4) 1400-1402
    CrossrefPubMedGoogle Scholar
  • 50 Lynch TH, Martínez-Piñeiro L, Plas E , et al; European Association of Urology. EAU guidelines on urological trauma. Eur Urol 2005; 47 (1) 1-15
    CrossrefPubMedGoogle Scholar
  • 51 Sandler CM, Goldman SM, Kawashima A. Lower urinary tract trauma. World J Urol 1998; 16 (1) 69-75
    CrossrefPubMedGoogle Scholar
  • 52 Alperin M, Mantia-Smaldone G, Sagan ER. Conservative management of postoperatively diagnosed cystotomy. Urology 2009; 73 (5) 1163.e17-1163.e19
    PubMedGoogle Scholar
  • 53 Lee J, Darcy M. Renal cysts and urinomas. Semin Intervent Radiol 2011; 28 (4) 380-391
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Titton RL, Gervais DA, Hahn PF, Harisinghani MG, Arellano RS, Mueller PR. Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics 2003; 23 (5) 1133-1147
    CrossrefPubMedGoogle Scholar
  • 55 Gayer G, Zissin R, Apter S , et al. Urinomas caused by ureteral injuries: CT appearance. Abdom Imaging 2002; 27 (1) 88-92
    CrossrefPubMedGoogle Scholar
  • 56 Ghali AM, El Malik EM, Ibrahim AI, Ismail G, Rashid M. Ureteric injuries: diagnosis, management, and outcome. J Trauma 1999; 46 (1) 150-158
    CrossrefPubMedGoogle Scholar
  • 57 Testa AC, Gaurilcikas A, Licameli A , et al. Sonographic imaging of urinoma. Ultrasound Obstet Gynecol 2009; 33 (4) 490-491
    CrossrefPubMedGoogle Scholar
  • 58 Lang EK, Glorioso III L. Management of urinomas by percutaneous drainage procedures. Radiol Clin North Am 1986; 24 (4) 551-559
    PubMedGoogle Scholar
  • 59 Anderson H, Alyas F, Edwin PJ. Intra-urinoma rendezvous using a transconduit approach to re-establish ureteric integrity. Cardiovasc Intervent Radiol 2005; 28 (1) 95-97
    CrossrefPubMedGoogle Scholar
  • 60 Horikami K, Matsuoka Y, Nagaoki K , et al. Treatment of post-traumatic urinoma by means of selective arterial embolization. J Vasc Interv Radiol 1997; 8 (2) 221-224
    PubMedGoogle Scholar