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Options in Management

Donald E. Fry, MD; Linda Milholen, MD; Phil J. Harbrecht, MD

Arch Surg. 1983;118(4):454-457.

Abstract
• Twenty-five patients sustained 27 iatrogenic ureteral injuries during various operative procedures. Injuries were managed by ureteroureterostomy in 11 injuries, ureteroneocystostomy in 11, nephrectomy in two, ureteral stent in one, cutaneous ureterostomy in one, and reimplantation into an ileal conduit in one. Four of 25 patients died, three as a result of the failure of ureteral repair and intra-abdominal sepsis. Short-term failure of repair occurred in five patients; long-term failure occurred in three. All patients with injuries missed during the primary operation had poor results of ureteral reconstruction. Immediate recognition of accidental ureteral injury provides optimum results. Injuries within 4 cm of the ureterovesical junction are managed by ureteroneocystostomy; injuries greater than 4 cm, by ureteroureterostomy. Crush injuries require immediate placement of a ureteral stent. Prior pelvic radiotherapy or intra-abdominal infection should preclude any attempt at primary reconstruction.

(Arch Surg 1983;118:454-457)

Author Affiliations
From the Surgical Service, Louisville Veterans Administration Medical Center (Drs Fry and Milholen), and the Department of Surgery, University of Louisville School of Medicine (Drs Fry and Harbrecht). Dr Fry is now with the Department of Surgery, Veterans Administration Medical Center, Cleveland.

Footnotes
Accepted for publication Dec 10, 1982.

Read before the Sixth Annual Surgical Symposium of the Association of Veterans Administration Surgeons, Atlanta, May 14, 1982.

Reprint requests to Department of Surgery, Ambulatory Care Bldg, University of Louisville School of Medicine, Louisville, KY 40292.

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