There was no increase in the rate of urologic ureteral injuries occurring at our medical center (Table 2). Of the urologic injuries, 32 of 37 (86%) occurred during ureteroscopic stone removal, 3 of 37 (8%) occurred during percutaneous nephrostolithotomy, and 1 of 37 (3%) occurred each during robotic prostatectomy, and transurethral resection of bladder tumor (TURBT). Ureteroscopic stone removal accounted for 11 of 13 Inhibitors,research,lifescience,medical (85%) of major urologic iatrogenic ureteral injuries in period 1

and 21 of 24 (88%) in period 2 (Table 3). Among urologic injuries, 19 of 37 (51%), 5 of 37 (14%), and 13 of 37 (35%) involved the proximal, middle, and distal ureter, respectively. Table 2 Ureteral Injuries Occurring at Wake Forest University Table 3 Surgical Procedures Taking Place at the Time of Injury General Surgical Injuries Twenty-two injuries occurred during general surgical procedures, 14 of which occurred at our institution. The general surgery injury rate Inhibitors,research,lifescience,medical per 10,000 admissions increased from 2.06 to 5.33 across the two time periods but was not statistically significant (P = .055) (Table 1). The rate for general surgical injuries occurring at our institution increased from 0.41 per 10,000 admissions to

4.08 per 10,000 admissions (P = .006) (Table 2). Open colectomy was responsible for 14 of 22 (70%) of Inhibitors,research,lifescience,medical general surgical injuries (Table 4), and 18 of 22 (81%) involved the distal ureter. Table 4 Management Techniques for Ureteral Injuries by Location of Injury Gynecologic Injuries A total of 18 injuries occurred during gynecologic procedures. There were no significant changes Inhibitors,research,lifescience,medical in the incidence of

gynecologic injuries as a whole or institutionally across the two time periods. The gynecologic injury rate was 17.84 and 6.23 per 10,000 admissions for the two time periods (P=.63). Radical hysterectomy was responsible for 11 of 18 (61%) (Table 3), and 16 of 18 (89%) Inhibitors,research,lifescience,medical involved the distal ureter. Reconstructive Results A total of 70 reconstructive operations were performed. Nine patients were lost to follow-up. The mean RG7204 supplier follow-up (± SE) was 32 ± 3.64 months (range, 1–108 months). There was no radiographic evidence of obstruction of the Bay 11-7085 involved kidney at the last time of follow-up as assessed by nuclear renography or intravenous pyelography for those patients with documented follow-up. One of the 18 patients subjected to ileal ureter reconstruction required a revision that was successful. Seven patients were subjected to nephrectomy as the involved renal unit had negligible function and the other renal unit was functioning normally. Discussion Our current study demonstrates that the most common procedure associated with major iatrogenic ureteral injury is now ureteroscopic stone removal.