Surgical Injuries to the Ureter

In a series of 31 patients with surgical injury to the ureters, the most frequent causes of trouble were a difficult operation within the pelvis, inadequate exposure, and persistent bleeding. More frequent preoperative use of the excretory urogram is recommended. The preoperative insertion of indwelling ureteral catheters is helpful but often difficult; hence, visual exposure of the ureter seems desirable. If the injury is recognized at the time of operation, a spatulated end-to-end anastomosis or reimplantation into the bladder with splints is preferred. When the injury becomes apparent during convalescence, immediate repair has given acceptable results. In the present series, which included 2 cases of bilateral injury, 27 kidneys were salvaged and 5 nephrectomies were done.