AUTHOR REPLY

Abstract

We appreciate the thoughtful commentary and agree with the points that were raised. As mentioned in the editorial, early repair is often easier when significant inflammation has not been allowed to set in. Barriers to early repair are numerous. If a ureteral injury is identified intraoperatively, a urologist may not be available for repair, as may occur if the inciting surgery is performed at an ambulatory surgery center or institution without routine urologic coverage. If a urologist is available, they may not feel comfortable with repair. If the reason is due to lack of experience with minimally-invasive ureteral reconstruction, the patient would most benefit from conversion to an open approach with immediate repair after a discussion with the patient's family. Although this conversion increases the morbidity to the patient, it pales in comparison to the morbidity of temporary nephrostomy tube or catheter drainage with delayed repair. If the urologist has limited experience with performing a ureteral reimplantation, temporary drainage with immediate transfer to a center with experience in ureteral reconstruction for early repair allows the patient to avoid months of morbidity. We are often hopeful that placement of a ureteral stent will be sufficient in healing a ureteral injury. Although it has success with grade 1 injuries, those of higher grade will likely develop a stricture or persistent leak requiring reconstruction at a later date if not repaired immediately.