Outcomes of ureteroscopic double-J ureteral stenting for distal ureteral injury after gynecologic surgery

Ureteral injuries are well-known complications of any gynecologic surgery. We evaluated the safety and feasibility of ureteroscopic double-J (DJ) ureteral stenting in patients with distal ureteral injuries after gynecologic surgery. Eleven consecutive patients with an iatrogenic ureteral injury in the distal ureter secondary to gynecologic surgery underwent DJ ureteral stenting between March 2008 and January 2016. Ureteral leakage and stricture were appraised using intravenous pyelography. The operative and clinical outcomes were evaluated. The DJ ureteral stent was successfully inserted using ureteroscopy in all patients, none of whom showed major or minor complications during the intraoperative and perioperative follow-up periods. Intravenous pyelography performed every 3 months during the follow-up period verified recovery at the ureteral injury site, without urine leakage. However, five patients experienced ureteral stricture. Balloon dilatation or Holmium laser endoureterotomy was performed successfully in all patients. One patient with recurring ureteral stricture was retreated using Holmium laser endoureterotomy and balloon dilatation; during 12 months of follow-up, there was no recurrence. Overall long-term success rate was 100%, with a mean follow-up of 20.4 months. DJ stenting using ureteroscopy diminishes the necessity for invasive surgical procedures and is regarded as one of the available management options for patients with an iatrogenic ureteral injury before considering an invasive operation. However, since ureteral stricture frequently occurs after ureteroscopic procedures, it is essential to select the appropriate patients.