THERAPEUTIC MANAGEMENT OF IATROGENIC URETERAL INJURIES: SURGICAL APPROACHES

Abstract

Introduction: Iatrogenic ureteral injuries (IUIs) constitute a serious surgical complication, associated with high morbidity, increased length of hospital stay, and a significant risk of renal function loss, especially when the diagnosis is made late. Despite advances in minimally invasive surgical techniques, gynecological surgery remains the main etiology of these injuries, which are frequently not recognized intraoperatively. In this context, early identification of the ureter, the appropriate choice of repair technique, and the implementation of preventive strategies are fundamental to optimizing clinical outcomes. Objective: The objective of this study was to synthesize recent scientific evidence regarding the therapeutic management of iatrogenic ureteral injuries, with emphasis on surgical and interventional approaches. Methodology: This is a narrative literature review, conducted in the PubMed database, using the descriptors Ureter Injuries, Therapy, and Diagnosis, combined with Boolean operators AND and OR, according to MeSH terminology. Articles published in the last five years, in English and available in full text, that directly addressed the therapeutic management of urinary incontinence lesions (UILs) were included. Duplicate publications, studies with low methodological rigor, and works unrelated to the central theme were excluded. Results: The results show that late diagnosis is strongly associated with a greater number of secondary interventions, prolonged hospitalization, and increased complications, such as ureterovaginal fistulas, especially after laparoscopic gynecological surgeries. The choice of surgical repair technique depends mainly on the location and extent of the lesion, with ureteroneocystostomy standing out as the preferred approach for lesions of the distal third of the ureter, with effective and less invasive laparoscopic technical variations in selected cases. Laparoscopic ureteroureterostomy proved to be a safe and effective alternative, especially in distal thermal lesions, preserving ureteral anatomy and reducing the risk of vesicoureteral reflux. In situations where immediate surgical intervention is not possible, interventional radiology, through percutaneous nephrostomies and ureteral stents, presents high rates of technical success. In the field of prevention, innovative technologies, such as near-infrared fluorescent stents, have demonstrated potential to increase intraoperative safety, while prior identification of risk factors and careful surgical exploration remain essential, especially in resource-limited settings. Conclusion: It is concluded that the effective management of iatrogenic ureteral injuries depends on early recognition of the injury, individualization of the therapeutic strategy, and the adoption of preventive measures aimed at preserving renal function and reducing associated complications.