Early, Aggressive Management of Intraoperative Ureteral Injuries

Abstract

Most urologic surgeons prefer proximal urinary diversion as an initial step in the repair of intraoperative ureteral injuries but an early direct attack on the injured area is being attempted more often. Ureteral injuries (36) in 24 patients during the last 5 yr is reported. In 19 patients 20 injuries were recognized and managed during postoperative convalescence. Repair consisted of ureteroneocystotomy in 8 patients, ureteroureterostomy in 6 and ureteral deligation in 4. Ureteral catheter manipulation alone was successful in 2 cases. Satisfactory ureteral repair was achieved in 23 patients. Definitive management was initiated upon diganosis in all but 1 patient. Early, direct, aggressive approach to the injured area whenever possible is recommended.