Ureteral Injury - JFrischer

Ureteral Injury - JFrischer - Pelvic malignancy present in...

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Iatrogenic Ureteral Injury 75% of ureteral injuries occur during gynecologic surgery 0.4% to 2.5% for benign disease Only 1/3 recognized at time of surgery
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Ureteral Anatomy Lies Anterior to psoas Crosses over the iliacs Rt. over external Lt. Over common Crossed anteriorly by the gonadal vessels
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Ureteral Blood Supply Unique Renal, ovarian, common iliac, and aorta Abdominal ureter receives its blood supply from the medial side Pelvic ureter receives its blood supply from the lateral side
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Common Sites of Ureteral Injury
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Risk Factors for Ureteral Injury Most cases do NOT have an identifiable risk factor Disruption of normal anatomy Endometriosis, ovarian masses, Inflammation (Diverticulitis, PID)
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Unformatted text preview: Pelvic malignancy present in 44% of cases Previous pelvic surgery Pelvic radiation Ureteral Injury Repair Depends on cause, location, and extent Minor trauma (ligature or crush) may be managed with stent and drainage Partial transection corrected with suture repair or resection Lower third Primary ureteroureterostomy (ligation) Bladder tube flap (Boari flap) Transureteroureterostomy (extensive urinoma or pelvic infection Procedure of choice: Psoas Hitch Psoas Hitch Procedure Ureteral Injury Repair Mid Ureter: Primary ureteroureterostomy Transureteroureterostomy Upper Ureter: Autotransplant kidney Transposition of bowel...
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Ureteral Injury - JFrischer - Pelvic malignancy present in...

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