Treatment of Ureteral Injury Recognised Immediately Intraoperatively in a Haemodynamically Stable Patient
Clinical Scenario
An iatrogenic ureteral injury is identified at the time of surgery, before the procedure is concluded. The patient remains haemodynamically stable throughout, making immediate definitive repair both feasible and the preferred course of action.
Why Immediate Repair Matters
When the injury is caught intraoperatively and the patient is stable, evidence strongly supports addressing it at that moment. Delayed repair is associated with a significantly greater need for secondary or tertiary interventions. A damage-control approach — with urinary diversion and later reconstruction — is reserved for unstable trauma patients and does not apply in this setting.
Treatment Approach (Partial Overview)
Management depends on the nature of the injury. The approach may involve de-ligation and stent placement, stenting or urinary diversion for partial injuries, or surgical reconstruction for complete injuries — including techniques that can be performed laparoscopically with good medium-term outcomes. The full step-by-step protocol, including technique selection, is available via the link below.
References
- Repair iatrogenic ureteral injuries recognised during surgery immediately.
- 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.
- A ligation injury during an operation can be managed by de-ligation and stent placement.
- Partial injuries can be repaired immediately with a stent or urinary diversion via a nephrostomy tube.
- Immediate repair of complete ureteral injury is advisable as it significantly decreases the need for secondary or tertiary procedures compared to delayed repair.
- The ureter is mobilised on both ends and a spatulated end-to-end anastomosis is performed.
- Primary repair by uretero-ureterostomy or ureteric re-implantation can be safely performed laparoscopically at the time of the iatrogenic injury, with good medium-term results.
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