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4.4.3 Ureteric injury

Ureteric injury may occur by laceration, crushing or errant suture placement.

  • Risks include:
    • Extension of the angles of a transverse incision
    • Hysterectomy
    • Deep bladder lacerations that involve the trigone
  • Presentation:
    • Many ureteric injuries are not appreciated at the time of cesarean section. 
    • Postoperative fever, flank pain and abdominal distention may indicate an unrecognized ureteric injury. 
    • Have a high index of suspicion. Prompt investigation with imaging and consultation (if possible, to urology, gynecological oncology, or general surgery) can help prevent long term sequelae. 
  • To repair:
    • Visualize ureteric jets directly via a bladder defect, or by cystoscopy. 
    • Cannulate ureters under direct visualization through the bladder defect.
    • Place stents intra-operatively.

Updated on June 28, 2021

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