Product Summary: AMA rates

Repair of ureteric injury

Item Number: 36573, 105

Infrequently ureteric injuries can occur with other abdominal surgery i.e.:

  • Hysterectomy.
  • Ovarian mass resection.
  • Bowel resections.
  • Sacro Colpo-pexy.

If the injury is below the pelvic brim then a re-implation with is recommended with Boari flap, otherwise a primary end-to-end anastomosis

Why is it done?

  • Stricturing or narrowing of the ureter causing significant hydronephrosis.
  • Injury to ureter with Urological surgery can cause this: Ureteroscopy.
  • Injury to the ureter from other surgeries: Colorectal, Gynaecological.
  • This injury if not noted may lead to chronic infection.
  • End-result is loss of renal function.
  • An end to end anastomosis can be considered in the mid ureter.
  • A Reimplantaion into the bladder with lower ureteric strictures.
  • A pelvi-ureteric junction repair in higher ureteric strictures.
  • A trans uretero-ureteric anastomosis joining one ureter to the other where long defects are present.
  • Renal Auto Transplantation where ureter is completely damaged or an ileal ureteric substitution where the whole ureter is damaged.

How is it done?

  • Laparoscopic technique.
  • Patients will receive a general anaesthesia.
  • Prophylactic antibiotics is given.
  • The correct ureteric system is identified and marked while you are awake.
  • This will be mostly a laparoscopic procedure.
  • Laparoscopic ports are placed, 1 for camera and 1-2 as working ports.
  • The affected ureter is exposed, The defect cut out with a re-anastomosis of a spatulated proximal ureter to a the distal ureter over a ureteric stent.
  • An indwelling catheter is placed.
  • A drain is placed.

What next?

  • You may be in hospital overnight.
  • Your catheter will be removed the following day. Or as soon as your urine is clear.
  • As soon as you are comfortable with no signs of pain and emptying your bladder sufficiently, you will be discharged.
  • A ward prescription may be issued on your discharge, for your own collection at any pharmacy.
  • A follow-up appointment will be scheduled for 6 weeks to remove your ureteric stent under local anaesthesia with a Flexible Cystoscope.
  • A review with a CT IVP will be scheduled 6 weeks after this to check on the end result of the ureter.
  • Any pain or signs of fever require an urgent review.
  • Don’t hesitate to ask Jo if you have any queries.

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Ureteric Injury