Early, aggressive management of intraoperative ureteral injuries.
Most urologic surgeons prefer proximal urinary diversion as an initial step in the repair of intraoperative ureteral injuries but an early direct attack on the injured area is being attempted more often. Our report concerns 36 ureteral injuries in 24 patients during the least 5 years. In 19 patients 20 injuries were recognized and managed during postoperative convalescence. Repair consisted of ureteroneocystotomy in 8 patients, ureteroureterostomy in 6 and ureteral deligation in 4. Ureteral catheter manipulation alone was successful in 2 cases. Satisfactory ureteral repair was achieved in 23 patients. Definitive management was initiated upon diagnosis in all but 1 patient. We recommend an early, direct, aggressive approach to the injured area whenever possible.