Immediate management of the injured ureter.

Abstract

• Serious injuries to the ureter have often resulted during trauma, such as stab and gunshot wounds, to the abdominal or pelvic organs, but they also occur occasionally during surgical procedures on neighboring structures, diagnostic procedures such as cystoscopy, and therapeutic procedures such as irradiation. Preoperative urographic study is important in planning the operative attack on certain abdominal, pelvic, and retroperitoneal [ill]paces. Preoperative introduction of ureteral catheters should be utilized more frequently to facilitate identification of the ureters during difficult dissections. The unintended inclusion of a ureter in a ligature must be corrected promptly; the release of such a ligature is more readily accomplished by teamwork between the surgeon and the urologist. The possibility that a ureter has been injured should always be considered whenever oliguria or anuria is observed during the first eight hours after any surgical operation in the vicinity of the ureters. If evidence of injury or ligation is found, prompt repair, with provision for tissue drainage, is imperative.