URETERAL INJURY Ureteral injuries are often subtle, and clinicians must have a high index of suspicion for them. An unrecognized or mismanaged ureteral injury can lead to significant complications, including urinoma, abscess, ureteral stricture, and potential loss of ipsilateral kidney

1. URETERAL INJURY
Causes and treatment
Jegannath Ambika Kumary Sanal

2. Ureteral injury
Ureteral injury

3. Ureteral injury – Etiology
1. Iatrogenic : Gynaecological pelvic surgeries etc,
2. Blunt trauma: Deceleration and Hyperextension of spine
3. Penetrating: Gun shot wound

4. Etiology - Iatrogenic Injury
 It occurs most commonly in hysterectomy
 Uterine artery and ureters are near to each other so
sometimes in hysterectomy the gynaecologist may
ligate the ureters instead of uterine artery

5. Etiology - Blunt trauma
 Deceleration and hyper extension of spine due to
accidents
 The Hyperextension of spine can cause Ureteral injury

6. Etiology – Penetrating
 Gun shot Wound
 Stab wound

7. Symptoms
 Asymptomatic (Mainly in ligation injury)
Because of ligation the urine cannot be drained this can
cause atrophy of the distal end of the kidney,
 Symptomatic
1. Loin pain
2. Fever
3. Sometimes It can get infected leading to pyonephrosis in
severe cases
4. Urinary Fistula
5. Anuria in case of bilateral injury

8. Diagnosis
1. Dye test
 Injecting Dyes like methylene blue and indigo carmine into the ureter
and Checking for any leakage
2. Retrograde Ureterography (Most sensitive)
3. Multi phase CT scan
Normal
Showing leakage

9. Treatment
 Treatment mainly depends upon the length of
the loss of ureter

10. Treatment
 If the loss of length is small =>
Anastomosis
 If it is near the kidney =>
Mobilise the kidney downwards and
Suture it

11.  If the loss of length is near the bladder => 2 methods
1. Psoas Hitch
 Mobilise the bladder upwards attach it with ureter and fix
it to the Psoas muscle to prevent it from descending
Downwards
Treatment

12. 2. Boari Bladder flap technique
 Refashion the bladder into a tube and then attach it to
the ureter
Treatment

13.  If there is a significant loss of length of ureter
1. Transuretro uretrostomy
Connect the injured ureter to other ureter and
Anastomose it
Treatment

14.  Interposition of Bowel loop
Treatment
 Nephrectomy.