The Predictive Factors of Renal Loss After Iatrogenic Ureteral Avulsion in the Medicolegal Perspective

Ali Ihsan Tasci; Yavuz Onur Danacioglu; Fatih Akkas; Salih Polat; Yusuf Arikan; Ekrem Guner; Feyzi Arda Atar; Yalcin Buyuk

doi:10.14744/SEMB.2022.92603

The Predictive Factors of Renal Loss After Iatrogenic Ureteral Avulsion in the Medicolegal Perspective

Sisli Etfal Hastan Tip Bul. 2023 Mar 21;57(1):92-98. doi: 10.14744/SEMB.2022.92603. eCollection 2023.

Authors

Ali Ihsan Tasci¹, Yavuz Onur Danacioglu¹, Fatih Akkas², Salih Polat³, Yusuf Arikan⁴, Ekrem Guner¹, Feyzi Arda Atar⁵, Yalcin Buyuk⁶

Affiliations

¹ Department of Urology, University of Health Sciences Türkiye, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye.
² Department of Urology, Erzurum Regional Training and Research Hospital, Erzurum, Türkiye.
³ Department of Urology, Amasya Training and Research Hospital, Amasya, Türkiye.
⁴ Department of Urology, Mus State Hospital, Mus, Türkiye.
⁵ Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Türkiye.
⁶ The Council of Forensic Medicine, Istanbul, Türkiye.

Abstract

Objectives: As an effective and minimally invasive technique, ureteroscopy has some potential intraoperative complications. Ureteral avulsion is among these complications, although rare. This study aimed to determine factors predicting nephrectomy by considering ureteral avulsion from a medicolegal perspective for the 1st time in the literature.

Methods: A total of 33 patients with ureteral avulsion during ureteroscopic surgery, who presented to various hospitals in Turkey between September 2004 and April 2019 and whose cases were being reviewed at the Institution of Forensic Medicine with regard to malpractice, were evaluated retrospectively. The patients who underwent nephrectomy after ureteral avulsion were evaluated as Group 1, and those who underwent reconstructive surgery as Group 2.

Results: The mean age of the patients was 39.5±12.1 years. Seventeen (51.5%) patients had partial and 16 (48.4%) had complete ureteral avulsion. Nephrectomy was performed in 14 (42.4%) patients, and ureteral reconstruction in 19 (57.5%) patients. It was determined that the patients in Group 1 had more proximal stones and a higher degree of hydronephrosis compared to Group 2. Complete avulsion developed in 71.4% of the patients in Group 1 and in 31.6% of those in Group 2. After avulsion, 78.6% of the patients in Group 1 were treated in a state hospital, and 63.2% of those in Group 2 were treated in a tertiary referral hospital. The increase in the degree of hydronephrosis, presence of complete avulsion, and intervention at a state hospital were determined as independent predictive factors for nephrectomy.

Conclusion: This is the first study with the largest cohort in the literature to medicolegally evaluate ureteral avulsion and determine predictive factors for nephrectomy. Although each patient should be treated with different methods in the presence of ureteral avulsion, our study aimed to provide a common approach to this catastrophic complication.

Keywords: Medicolegal perspective; Nephrectomy; Ureteral avulsion; Ureteroscopy.