Ureteral Injury Recognised Immediately During Surgery — Management in Haemodynamically Stable Patients
When ureteral injury is identified intraoperatively at the time it occurs, and the patient remains haemodynamically stable, immediate definitive repair is the preferred approach — distinct from the damage-control strategy reserved for unstable patients.
Clinical scenario
Ureteral injury recognised immediately, intraoperatively during surgery, in a patient with no haemodynamic instability. Prompt identification creates the opportunity for direct, definitive management rather than staged intervention.
Approach overview
Management may involve urinary diversion procedures, with the specific choice dependent on the injury characteristics and intraoperative findings. In a subset of cases where repair fails or renal function is compromised, more definitive surgical options may be required.
The full structured regimen — including sequencing, criteria for each option, and decision points — is available via the complete protocol.
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.
- Following early or late repairs, up to 38% of patients develop secondary ureteric strictures requiring interventions or palliative management by indwelling ureteric catheter or nephrostomy tube.
- Moreover, in some series up to 10% of failed repairs have evidence of renal parenchyma or function loss, leading to nephrectomy.
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