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Case Reports in Urology
Volume 2014, Article ID 308093, 6 pages
Case Report

Possible Complications of Ureteroscopy in Modern Endourological Era: Two-Point or “Scabbard” Avulsion

1Vilnius University, Siltnamiu 29, LT-01430 Vilnius, Lithuania
2Vilnius University, Universiteto 3, LT-01122 Vilnius, Lithuania
3Republic Vilnius University Hospital, Siltnamiu 29, LT-01430 Vilnius, Lithuania
4Vilnius University, Santariskiu 2, LT-08861 Vilnius, Lithuania

Received 30 May 2014; Revised 9 October 2014; Accepted 13 October 2014; Published 28 December 2014

Academic Editor: Michele Gallucci

Copyright © 2014 Andrius Gaizauskas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Indication has led ureteroscopy to be a worldwide technique, with the expected appearance of multiple types of complications. Severe complications are possible including ureteral perforation or avulsion. Ureteral avulsion has been described as an upper urinary tract injury related to the action of blunt trauma, especially from traffic accidents, being the mechanism of injury, the result of an acute deceleration/acceleration movement. With the advent of endourology, that term is also applied to the extensive degloving injury resulting from a mechanism of stretching of the ureter that eventually breaks at the most weakened site, or ureteral avulsion is referred to as a discontinuation of the full thickness of the ureter. The paper presents a case report and literature review of the two-point or “scabbard” avulsion. The loss of long segment of the upper ureter, when end-to-end anastomosis is not technically feasible, presents a challenge to the urological surgeon. In the era of small calibre ureteroscopes these complications, due to growing incidence of renal stones will become more and more actual. Our message to other urologists is to know such a complication, to know the ways of treatment, and to analyse ureteroscopic signs, when to stop or pay attention.