Specific Features of Treatment of Intraoperative Ureteral Injuries Complicated by Peritonitis

BACKGROUND: Ureteral injury is a rare condition, accounting for less than 3% of all urinary tract injuries. The majority of ureteral injuries are iatrogenic. Intraoperative ureteral injuries are identified late in 75% of cases, which leads to the development of post-traumatic complications. The timing of peritonitis manifestation after ureteral transection or thermal damage varies, affecting treatment strategy.

AIM: To determine the optimal treatment strategy for intraoperative ureteral injury complicated by urinary peritonitis.

METHODS: This retrospective study included 26 patients treated at the I.I. Dzhanelidze Research Institute of Emergency Medicine between 1998 and 2022 for intraoperative ureteral injury complicated by urinary peritonitis.

RESULTS: The median patient age was 51 years [Q₁ 41; Q₃ 66]. Among the surgical interventions leading to intraoperative ureteral injury, gynecological operations were the most common. The time to detection of urinary peritonitis ranged from 11 to 103 hours after the initial surgery. Urinary peritonitis was detected in the reactive phase in 8 patients, in the toxic phase in 6, and in the terminal phase in 12. Surgical treatment was performed in all cases of urinary peritonitis. Primary reconstructive surgery was performed in 13 (50%) patients. In 10 cases (38.5%), staged procedures were required before reconstructive ureteral surgery could be performed. In 3 patients (11.5%), reconstructive surgery was not carried out; instead, permanent drainage of the upper urinary tract using a nephrostomy was performed.

CONCLUSION: If intraoperative ureteral injury is identified during the reactive or toxic phase of urinary peritonitis, reconstructive surgery may be performed. In the terminal phase of peritonitis, only staged procedures aimed at draining the upper urinary tract should be performed.