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Management of the Ureter During Pelvic Surgery

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Urological Emergencies

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

The ureter’s anatomic characteristics make it susceptible to iatrogenic injury. Most major ureteral injuries occur during gynecologic procedures, although any abdomino-pelvic surgery can result in trauma to the ureter.

As with all injuries, prevention is the goal. Awareness of ureteral anatomy and appropriate exposure and visualization are essential in avoiding injury. Intraoperative ureteral stenting may aid in ureteral identification but has not been shown to prevent injury or limit complications.

Prompt injury recognition is important in minimizing morbidity and preserving renal function. Management depends on the timing of diagnosis, the patient’s overall condition and the extent and mechanism of injury. Many iatrogenic injuries will heal with urinary diversion alone. When necessary, the appropriate reparative procedure should be performed from the substantial armamentarium of reconstructive options.

Maintaining a high index of suspicion and adhering to sound diagnostic and therapeutic principles are paramount in promptly diagnosing and effectively managing any ureteral injury.

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Authors and Affiliations

  1. Department of Urology, Weill Cornell Medical School, Lenox Hill Hospital and New York Presbyterian Hospital, 880 Fifth Avenue, New York, NY, 10021, USA

    Noel A. Armenakas MD

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  1. Noel A. Armenakas MD
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Correspondence to Noel A. Armenakas MD .

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  1. School of Medicine, Harborview Medical Center, University of Washington, 1959 NE Pacific Street Box 356510, Seattle, 98195, Washington, USA

    Hunter Wessells

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Armenakas, N.A. (2013). Management of the Ureter During Pelvic Surgery. In: Wessells, H. (eds) Urological Emergencies. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-423-4_21

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  • DOI: https://doi.org/10.1007/978-1-62703-423-4_21

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  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-62703-422-7

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