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.