Gynecologic Ureteral Injury

Abstract

Various lesions predispose to ureteral injury during operation. Adequate exposure and direct visualization of the ureters early in the operative procedure are the best preventive measures. Early repair ranges from removal of a clamp or ligature to splinting with a catheter, end-to-end anastomosis, or reimplantation into the dome of the bladder or into a flap. Renography utilizing radioisotopes is very helpful in distinguishing between ureteral injury and acute renal shutdown postoperatively. Re-exploration is preferable to immediate nephrostomy if catheters cannot be passed. Temporary nephrostomy and even nephrectomy must be considered when ureteral obstruction occurs late in convalescence.