Long Segment Ureteral Avulsion:Report Of 3 Cases And Analysis Of Prevention And Treatment

Objective:Retrospectively analyze 3 cases of long segment ureteral avulsion in order to provide reference for the prevention and treatment of the long segment ureteral avulsion.Materials and methods:A retrospective analysis was made on the clinical data of the patients with long segment ureteral avulsion who were treated in our hospital or Zhejiang Provincial People's Hospital from 2014 to 2016.Results:In our hospital,1 case of patient was treated by ileal ureter substitution.After 1 month,IVU showed no ureteral stricture and urinary extravasation.US showed mild or moderate left hydronephrosis.After 3 months,the D-J tube was removed.CT scan also showed mild or moderate left hydronephrosis.1 patient in Zhejiang Provincial People's Hospital was treated by laparoscopic ureteral reconstruction using bladder flap within 8 hours after avulsion.The results showed that there was mild right hydronephrosis after 2 months.After 3 months,CT scan also showed mild right hydronephrosis.IVU showed that the affected side developed normally,and there was no abnormal stricture and urinary extravasation.And the patient had no symptoms of frequent micturition.Flexible ureteroscopy showed that the ureter was unobstructed,and no stricture was found during the examination.The wound healed well in the area of the former anastomosis of bladder and ureter.1 case of patient in Zhejiang Provincial People's Hospital was also treated by laparoscopic ureteral reconstruction using bladder flap within 1 month after avulsion.The D-J tube was removed after 3 months after the operation.IVU showed normal development,and there was no abnormal stricture or urinary extravasation in the affected side.CT scan also suggested that there was no hydronephrosis.in the affected side.Conclusion:To the long segment ureteral avulsion,prevention should be primarily emphasized.In the ureteroscopy lithotomy,operation should be standardized and excessive force should not be used.When the long segment ureteral avulsion has already occurred,it is a reasonable optional remedy that the operation of ileal ureter substitution or ureteral reconstruction using bladder flap.