Ureteral Injury Recognised Immediately During Surgery in a Haemodynamically Stable Patient
When a ureteral injury is identified at the moment it occurs — during an ongoing surgical procedure — and the patient remains haemodynamically stable, immediate repair is both feasible and indicated. This scenario calls for a structured, evidence-based approach distinct from injuries that are diagnosed later.
Clinical scenario
Iatrogenic ureteral injury identified intraoperatively, at the time of surgery, in a patient without haemodynamic instability. Immediate surgical repair is pursued where possible; in unstable patients a damage-control strategy with urinary diversion would instead be employed.
Treatment approach
Management centres on an endo-urological approach targeting the ureteral injury — involving internal stenting as a key component of the intervention. The procedure can be carried out via more than one access route depending on the clinical situation.
The complete stepwise protocol, including access routes, technical details, and decision points, is available via the full structured regimen.
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.
- Endo-urological treatment of small ureteral fistulae and strictures is safe and effective.
- Endo-urological treatment of delayed-diagnosed ureteral injuries by internal stenting, with or without dilatation, is the first step in most cases.
- It is performed either retrogradely or antegradely via a percutaneous nephrostomy, and has a variable success rate of 14–19%.
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