Endoscopic management of iatrogenic ureteric strictures. Vijayanand.B , Sriram.K , Sunil Shroff. SRMC. History. 33 yr female Right loin pain, 4 weeks Fever since, 2 weeks. Difficulty in breathing , 1 week. Reduced urine output, 2 days. History. No co-morbid associated factors
Vijayanand.B , Sriram.K , Sunil Shroff.
After 6 weeks , surgery was planned.
Grade I (haematoma) - Contusion or Haematoma.
Grade II (laceration) - Less than 50% transection.
Grade III (laceration) - Greater than 50% transection.
Grade IV (laceration) - Complete transection with 2 cm of devascularization.
Grade V (laceration) - Avulsion with greater than 2 cm of devascularization.
usually involves the lower third
Ovarian vascular pedicle at infundibulo-pelvic ligament
Ureteric relation with the uterine artery.
Cardinal ligament, where the ureter crosses under the uterine artery.
Cardinal ligament tunnel, dorsal to the infundibulo -pelvic ligament near or at the pelvic brim.
Lateral rectal pedicles.
Pathological distortion of the ureteral anatomy.
Immediate - intra-op diagnosis.
Delayed - after few days to weeks.
Grade 3,4,5:(depending on the level of injury)
Short segment loss:
Long segment loss:
- Obstructive uropathy.
(using Ho:YAG Laser).
(depends on the type of ureteral injury).