UREMIA FOLLOWING LIGATION OF BOTH URETERS IN THE COURSE OF A HYSTERECTOMY: REPORT OF CASE; MANAGEMENT

Abstract

Ligation, severing or other injury of one ureter, during the course of certain pelvic operations, is occasionally observed. Cautery operations for carcinoma of the cervix sometimes result in damage to both ureters with sloughing and urinary fistulas. Crucial trauma to both ureters by ligature, division or destructive crushing is happily rare. If the condition is recognized before the abdomen is closed, it may be dealt with successfully by removing the catgut and performing immediate repair. But reopening the abdomen as late as from two to eight days subsequent to the original operation results in a high mortality rate, and one is frequently unsuccessful in removing the catgut except after a mutilating search. Caulk's¹investigation on seventy experimental animals (dogs) is convincing as regards the dangers and failures of deligation and as to the efficacy and comparative benignity of bilateral nephrostomy. The only remaining reasonable alternative is ureterovesical anastomosis, which