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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