Rama Garg

By Rama Garg

It is the most serious and trouble-some complication of pelvic surgery and common reason for medico-legal action by the patient. It can be unilateral or bilateral. Lowest 3 cm of ureter is usually injured. 75% of injuries result from gynecological operations - 3/4th during abdominal and 1/4th during vaginal operations. As most injuries can be diagnosed intraoperatively, systematic assessment of urinary tract integrity should be part of the surgical plan. Intraoperative cystoscopy using either flexible or rigid instruments can aid in the diagnosis or exclusion of urinary tract injury. Identification of the mechanism of injury and its location guides immediate or delayed repair. Mobilization should be sufficient to allow a tension-free closure. Tissue interposition is typically recommended. Common sites for ureteral injury are found beneath the uterine vessels near the cardinal ligament and beneath the infundibulopelvic ligament and the tunnel of Wertheim. Successful ureteral repair relies on careful mobilization, wide spatulation, use of fine absorbable suture (4-0, 5-0), and temporary stenting. Postoperative signs and symptoms of ureteral injury may include unilateral flank pain, fever, prolonged ileus, and abdominal or pelvic fluid collection (urinoma).

Part of the book: Urinary Tract Infection and Nephropathy