Ureteral Injury

CLINICAL FEATURES Operative injury to the ureter results from one of three types of trauma: crushing, transection, or ligation. Each type of injury may be either partial or complete. This complication occurs more often during the performance of abdominal hysterectomy than during any other pelvic surgery. In patients who develop flank pain shortly after surgery, ureteral injury should be suspected. Patients may have fever and costovertebral angle tenderness. A urinalysis should be performed, and if obstruction is suspected, an IVP should be obtained. If obstruction is noted on IVP, it is usually near the ureterovesical junction.

DISPOSITION Patients should be admitted for attempted ureteral catheterization under cystoscopic guidance and possibly exploratomy laporotomy. Percutaneous nephrostomy with delayed repair may also be considered.

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