DIAGNOSIS OF IATROGENIC URETERAL INJURIES: INTRAOPERATIVE IDENTIFICATION

Abstract

Iatrogenic ureteral injuries (IUIs) constitute a rare (0.5% to 1.3%) but serious surgical complication, with the highest incidence (69% to 75%) associated with gynecological surgeries, notably laparoscopic hysterectomy for benign indications. The main difficulty lies in intraoperative diagnosis, with most injuries going unnoticed (recognition between 25% and 45% of cases), which is directly correlated with a significant increase in morbidity, a greater number of secondary interventions, and prolonged hospitalizations. Thermal energy injuries are particularly challenging, manifesting late. To overcome the limitations of visual inspection, emerging technologies such as infrared fluorescence imaging (NIRF), using catheters or fluorescent dyes, show promise for real-time identification. The definitive management depends on the location, with ureteroneocystostomy being the preferred technique for the lower third and laparoscopic ureteroureterostomy for the middle/upper third. It is concluded that careful indication for the procedure and constant surgical training are vital for reducing damage and for immediate management, preventing late complications.