From the Guidelines
Management of a ureteral injury during stent placement requires prompt recognition and appropriate intervention, with the primary goal of preserving renal function and preventing long-term complications, as emphasized in the 2023 WSES guidelines 1. The first step is to complete the stent placement if possible to maintain urinary drainage and stabilize the patient. For minor injuries like mucosal tears, simply placing the stent across the injury site may be sufficient for healing. However, for more significant injuries such as perforation or avulsion, immediate urologic consultation is necessary. Treatment options include endoscopic management with stent placement for 4-6 weeks for small perforations, or surgical repair for larger injuries or complete avulsions, with the choice of technique depending on the location and extent of the injury, as well as the patient's condition 1. During the procedure, if resistance is encountered, forcing the stent should be avoided; instead, fluoroscopic guidance should be used to ensure proper placement. Post-injury, patients should receive appropriate antibiotics (such as ciprofloxacin 500mg twice daily or ceftriaxone 1-2g daily) to prevent infection, analgesics for pain control, and close follow-up with serial imaging to monitor healing, as recommended in the urotrauma guidelines 1. Some key considerations in the management of ureteral injuries include:
- The importance of prompt recognition and intervention to prevent long-term complications
- The use of endoscopic management with stent placement for minor injuries
- The need for surgical repair for more significant injuries
- The importance of fluoroscopic guidance during stent placement to ensure proper placement
- The need for close follow-up with serial imaging to monitor healing Ureteral injuries can lead to stricture formation, urinary extravasation, or urinoma development if not properly managed, which is why prompt recognition and appropriate intervention are crucial to prevent long-term complications and preserve renal function, as highlighted in the 2023 WSES guidelines 1.
From the Research
Management of Ureteral Injury During Ureteral Stent Placement
The management of ureteral injury during ureteral stent placement can be complex and may require various approaches. Some key points to consider include:
- The use of fluoroscopy and guidewires may help minimize complications during stent placement 2
- In cases of ureteral injury, percutaneous management with nephrostomy tube drainage and ureteral stenting may be effective 3, 4
- Double-J stent placement can be used to manage ureteral obstructions and leaks 3, 4
- Cutting balloon dilatation and tandem ureteral stent placement may be necessary in cases of resistant stenosis 4
Techniques for Ureteral Stent Placement
Some techniques for ureteral stent placement include:
- Cystoscopic placement of external, lighted, and internal ureteral stents 5
- Use of fluoroscopy to guide stent placement 5
- Placement of a guidewire followed by an open-ended ureteral catheter and retrograde pyelogram 5
- Deployment of the stent with the distal curl in the bladder 5
Complications of Ureteral Stent Placement
Some potential complications of ureteral stent placement include: