[Surgical treatment of iatrogenic lesions of the urinary tracts and their complications].

The article presents results of surgical treatment of 167 patients with iatrogenic urinary tract lesions made in the course of various surgical interventions. Ureteral trauma was detected in 106 (63.5%), urinary bladder trauma--in 44 (26.3%), urethral trauma--in 5 (3.0%) and trauma of the bladder and ureters--in 12 (7.2%) patients. Endoureterotomy was made in 7 (4.0%) patients with short ureteral stricture, intraoperative correction of ureteral injuries was made in 8 (4.6%) cases. Ureteroplasty according to the technique designed by the authors was conducted in one female patient. A variant of ureterocystoanastomosis (UCA) was created in 67 (38.8%) patients. Reconstruction of the urinary tract with an ileal graft was performed in 16 (9.3%) patients, with the appendix--in 4 (2.3%) patients. Intestinal plastic correction of the ureters and urinary bladder was made in 2 (1.2%) patients. In trauma of the urinary bladder in 3 (1.7%) patients it was sutured, 41 (23.7%) patients underwent transvaginal vesicofistuloraphy. Electrocoagulation of the vesicovaginal fistula and colpocleisis were performed in 8 (4.6%) patients. Plastic surgery of vesicorectal and urethrovaginal fistula was conducted in 3 (1.7%) and 5 (2.9%) patients, respectively. In postoperative period after reconstructive operations complications developed in 17 (10.2%) patients. Conservative treatment of the complications was carried out in 11 (6.6%) patients, reoperations were made in 6 (3.6%) patients: resection of the stricture of appendicocystoanastomosis with reanastomosis (n = 1), repeat UCA (n = 1), revesicofistuloraphy (n = 1) and electrocoagulation of recurrent fistula (n = 3). Rehabilitation was achieved in 98.8% patients. Obstruction of the ureters and urogenital fistulas are prevailing complications (93.4%) of iatrogenic injury of the urinary tract. Operations of choice in such complications are UCA and transvaginal fistuloraphy, respectively.