Chapter 46 · Postoperative and iatrogenic complications
Ureteral injury after gynecological and abdominal surgery
Definition
Ureteral injury is a rare but serious complication of pelvic surgery.
Most frequently implicated operations:
- Hysterectomy.
- Sigmoid colon resection.
- Surgery for ovarian or bladder cancer.
Clinical presentation
- Flank pain.
- Fever.
- Reduced urine output.
- Urine leakage through a drain.
- An unexplained rise in creatinine.
- Hydronephrosis on ultrasonography.
Diagnosis
- CT urography (extravasation, hydronephrosis).
- Retrograde pyelography (the gold standard when planning stent placement).
Emergency management
- Partial injury with preserved patency: stenting (antibiotics, monitoring of leakage).
- Complete transection or inability to place a stent: nephrostomy → delayed reconstruction.
- Intraoperative recognition: immediate reconstruction (reimplantation, ureteroureterostomy).
Algorithm
| Step | Action |
|---|---|
| 1 | Suspected injury (pain, fever, urine leakage) |
| 2 | CT urography |
| 3 | If feasible → stenting |
| 4 | If not feasible → nephrostomy |
| 5 | Delayed reconstruction |