Ureteral Injury Recognised Immediately Intraoperatively in a Haemodynamically Unstable Patient
When a ureteral injury is identified at the time of surgery in a patient who is haemodynamically unstable, the clinical picture demands a staged strategy that separates damage control from definitive repair. Immediate complex reconstruction is generally not feasible under these conditions, and the surgical approach must be adapted accordingly.
Ureteral injury recognised immediately (intraoperatively) in a haemodynamically unstable patient. In this setting, prioritising patient stability takes precedence over definitive ureteral reconstruction — a damage control approach is preferred, with ligation of the ureter and urinary diversion (such as nephrostomy), followed by delayed definitive repair once the patient is stabilised.
Management follows a two-stage plan: an initial damage control procedure to secure the injury and protect renal function, followed by delayed definitive open, laparoscopic or robot-assisted surgical reconstruction of the ureter. The specific reconstructive technique depends on the location and length of the affected ureteral segment.
Full details — including approach selection, technique options by injury level, and extended reconstruction strategies — are available in the structured protocol.References
- In cases of unstable trauma patients, a 'damage control' approach is preferred with ligation of the ureter, diversion of the urine (e.g. via a nephrostomy), and a later delayed definitive repair.
- Distal injuries are best managed by ureteral re-implantation (ureteroneocystostomy) because the primary trauma jeopardises the blood supply to the distal ureter.
- A longer ureteral injury can be replaced using a segment of the intestines, usually the ileum (ileal interposition graft).