Percutaneous management of iatrogenic ureteral injuries using a multistep approach: clinical, functional and long-term outcomes

Purpose Iatrogenic ureteral injuries, while uncommon, are increasingly recognized as a significant source of morbidity and mortality following surgical or medical procedures. The aim of our study is to present a multi-step anterograde approach to treating these injuries, discuss the outcomes, and attempt to classify the injuries based on the mechanisms that caused them. Materials and methods In this monocentric retrospective study, we evaluated patients who were treated for an IUI using a multistep, anterograde approach involving percutaneous nephrostomy, nephro-ureteral stenting, and anterograde stenting. Injuries were categorized as leakage, occlusive or mixed. Clinical success, drainage dependency, time-to-recanalization, ureteral recanalization rate, ureteral patency and kidney function post-intervention were evaluated as outcome measures. Results The study included 38 patients who underwent 44 procedures, with a mean follow-up of 4.2 years. The clinical success rate was 89.5%. The ureteral recanalization rate was 72.7% and, after 6 months, 16 lesions (66.7%) were stent-free. The outcome was significantly better in lesions recanalized within 5 days (p < 0.0001, OR 45.5). Leakage injuries had a higher chance of being recanalized (p = 0.0067, OR 0.1) and better kidney function (p = 0.009, OR 35.3) compared to non-leakage ones. A time to diagnosis < 5 days was associated with preserved kidney function (p = 0.0031, OR = 0.025). Conclusion Iatrogenic injuries can be effectively managed with a percutaneous anterograde approach, yielding favorable long-term outcomes. The type of injury and the time to diagnosis are critical factors that influence clinical results.