Spontaneous Healing of Iatrogenic Complete Ureteric Transection Injury

Iatrogenic ureteric injury is the most common cause of ureteric injury. It is usually caused by either gynecological or urological surgical procedures. Iatrogenic ureteric injury repair depends mainly on the time of diagnosis. We represent here a case of iatrogenic complete transection ureteric injury resulted from laparoscopic bilateral salpingo-oophorectomy. The patient had a history of abdominal hysterectomy causing adhesions that resulted in challenging surgery. One week later, the patient presented to the emergency department with abdominal pain, and contrast CT showed left hydronephrosis with extravasation of the contrast at the left renal pelvis. The patient was treated initially with left nephrostomy and an antegrade nephrostogram confirmed the diagnosis of complete transection ureteric injury. Surprisingly, left retrograde study, which was done 11 weeks after the operative injury, showed healing of the ureteric injury with a small annular stricture. The stricture was dilated and a stent was inserted. We concluded that conservative waiting and delayed ureteric repair might be advised in similar injuries allowing time for resolution of the postoperative inflammatory reaction and spontaneous healing.