Comparison of split-cuff nipple and modified Lich-Gregoir ureteroneocystostomy in iatrogenic distal ureteral injuries: tertiary care center experience

• Published in: International urology and nephrology Vol. 55; no. 3; pp. 605 - 611
• Main Authors: Demirdag, Cetin, Bulbul, Emre, Gultekin, Mehmet Hamza, Simsekoglu, Muhammed Fatih, Ilki, Fahri Yavuz, Kalender, Goktug, Citgez, Sinharib
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.03.2023; Springer Nature B.V
• Subjects: Complications; Iatrogenesis; Medicine; Medicine & Public Health; Nephrology; Patients; Postoperative; Success; Urology; Urology - Original Paper; Complication; Split-cuff nipple; Lich-Gregoir; Ureteroneocystostomy; Ureteral injury
• ISSN: 1573-2584; 0301-1623; 1573-2584
• DOI: 10.1007/s11255-022-03449-1

Purpose In this study, we aimed to compare the results of split-cuff nipple and modified Lich-Gregoir ureteroneocystostomy, which are the most commonly used techniques in stage ≥ 3 iatrogenic distal ureteral injuries. Methods The files of patients who were treated for iatrogenic distal ureteral injuries in our clinic between January 2013 and January 2019 were retrospectively reviewed. A total of 60 patients who underwent either intra-vesical split-cuff nipple ureteroneocystostomy (Group A) or extra-vesical modified Lich-Gregoir ureteroneocystostomy (Group B) operations were included in the study. The success of ureteroneocystostomy was defined as no additional surgery requirement, no progression of hydronephrosis on imaging, and normal contrast transition on imaging. Results Thirty-four patients underwent split-cuff nipple and 26 patients underwent modified Lich-Gregoir ureteroneocystostomy. The treatment was successful in 53 (88.3%) patients and failed in seven (11.7%). Complications occurred in 19 (31.7%) patients, of whom 14 (23.3%) had minor and five (8.3%) had major complications. The rate of postoperative complications was significantly higher in Group A than in Group B ( p  = 0.019). There was no significant difference between Group A and Group B in terms of the success ratio ( p  = 1), rate of major complications ( p  = 0.372), and postoperative hospitalization times ( p  = 0.254). Conclusion In this study, a higher complication rate was found in patients with iatrogenic ureteral injuries who underwent ureteroneocystostomy with the split-cuff ureteral nipple technique compared to those who underwent this operation with the modified Lich-Gregoir technique. However, no significant difference was observed between these two techniques in terms of treatment success and major complications.