X-ray endoscopic diagnosis and treatment of iatrogenic injuries of the upper urinary tract

X-ray endoscopic diagnosis and treatment of iatrogenic pelvoureteral injuries (PUI) were made in 200 patients (age 18-70 years, mean age 41.7 years, 68(34%) males, 132(66%) females). Preoperative examination was standard for obstructive diseases of the upper urinary tract (UUT). The end stage of the diagnosis included diapevtic transurethral ureteropyeloscopy or percutaneous nephroureteroscopy. In 57 (28.5%) patients x-ray and endoscopic diagnoses did not coincide. A total of 250 x-ray endoscopic operations were conducted. Direct dissection of the UUT stricture (obliteration) was made with a "cold" knife in 38.8% cases, with an uncinate electrode - in 14.8%, with a Ho laser applicator - in 46.4% cases. Patients with ureterovaginal (uterine) fistulas after relief of the obstruction have undergone ablation and coagulation of the fistula. UUT draining and splinting of the dissection zone were performed with "inner" stents 608 Fr in diameter and 24-28 cm long as well as with endopyelotomic stents 6-7 Fr with extention to 12-14 Fr. Draining of the kidney after percutaneous operation was made with pigtail drains 7-12 Fr and a long (35-50 cm) intubation drain tube 12-16 Fr in diameter. The drainage continued 4-12 weeks. Control examination took part in 6-12 months. Good and satisfactory results were achieved in 186 (88.2%) cases. Endourological reoperation was made in 33 patients, three times operative intervention was conducted in 6 patients. Basing on our findings, we have developed prognostic criteria of efficacy of PUI roentgenoendoscopic treatment which was effective in short strictures (obliterations) of the UUT in relatively intact renal function, absence of manifest UUT hypotension, when performed 3 weeks to 3 months after iatrogenic injury.