How is ureter injury diagnosed?
A retrograde pyelogram (RPG) is the most accurate imaging test to evaluate the location and extent of the ureteral injury. Antegrade pyelogram also can be performed if the patient has antegrade access. A CT urogram (CT abdomen and pelvis with IV contrast and delayed images) can accurately identify ureteral injury.
How do you know if your ureter is damaged?
Symptoms of Ureteral Injuries People with ureteral injuries may complain simply of pain in the abdomen or the area between the ribs and the hip (flank), or they may notice urine leaking from their wound. Fever may accompany an infection caused by persistent urinary leakage. Blood may appear in the urine.
What happens when the ureter is damaged?
If either ureter doesn’t work properly, urine can back up into the kidney and cause damage. A blockage (obstruction) where the ureter connects to the kidney or bladder. This prevents urine flow.
How do you manage ureteric injury?
In the case of distal ureteral injuries ureteroneocystostomy, with or without a vesico-psoas hitch, is the most commonly employed technique for management. If the injury is in the mid or proximal ureter then a ureteroureterostomy, transureteroureterostomy, or a Boari flap are commonly utilized.
How does a ureteral injury present?
More than 70% of the time, unilateral ureteral injury is noticed postoperatively. The patient may present with flank pain, prolonged ileus, fever, watery vaginal discharge, or mildly or significantly elevated serum creatinine levels. In cases of bilateral ureteral injury, anuria is the first clinical sign.
Which surgical procedure has the highest incidence of ureteric injury?
In the 2018 systematic review of urinary tract injury in gynaecological laparoscopy for benign indications, the highest incidence of ureteral injury was found in endometriosis resection (0.4%, 95% CI 0.3– 0.6) followed by laparoscopically assisted vaginal hysterectomy (0.2%, 95% CI 0.2–0.3) and laparoscopic …
Can damaged ureter repair?
Ureteral Trauma The ureters are tubes made of muscle to move urine from the kidneys to the bladder. If one or both are damaged, you will need surgery to repair them. If there is a limited tear to the ureters, stents or surgery can fix the tear.
How do you identify the ureter?
In cases of laparoscopic adnexectomy, the ureter can be identified transperitoneally as it courses over the pelvic brim. When approaching the cardinal ligament dissection during laparoscopic hysterectomy, a few techniques can help ensure that the ureter is sufficiently lateralized.
How long does ureter take to heal?
Studies of ureteral healing have demonstrated that the mucosa has healed by 3 weeks and muscular continuity is established by 7 weeks. Thus, many recommend that a stent remain in place for 6-8 weeks after a repair. Stents come in various diameters (4-8F) and lengths.
What is ureteral injury?
Ureteral injury is one of the most serious complications of gynecologic surgery. Less common than injuries to the bladder or rectum, ureteral injuries are far more serious and troublesome and when unrecognized are often associated with significant morbidity.
How is the diagnosis of ureteric injuries made?
The diagnosis is often based on a high index of clinical suspicion. The detection of ureteric injuries is delayed after days or weeks in approximately two-thirds of patients. There is a wide-range of injury:
Is ureteric injury a serious injury?
… Although ureteric injury is relatively uncommon, it is a serious event that can result in intra-abdominal sepsis, renal failure, and loss of the ipsilateral renal unit. Most injuries are iatrogenic and remain undiagnosed until the patient presents with symptoms postoperatively.
When to see a doctor for urethral injury?
For females, urethral injuries can also be caused by sexual assault. If you have blood at the end of the penis or in the urine or can’t pass urine after an injury to the urethral area, you should see a health care provider right away.
How are ureteral injuries managed during surgery?
If there is an intra-operative crush injury or ureteral contusion that is immediately identified, such as clamping the ureter, suturing the ureter, stapling the ureter, or applying a clip to the ureter, it can be managed based on the extent of injury. If it appears the injury is minimal, and the ureter is viable, place a ureteral stent.