Ureteric Injury

This chapter addresses ureteric injury in open surgery, citing case studies that help in the management of ureteric injury in laparoscopic surgery. Risk factors for ureteric injury include an enlarged uterus, previous pelvic surgery, ovarian neoplasms, endometriosis, pelvic adhesions, distorted pelvic anatomy, coexistent bladder injury, massive intraoperative hemorrhage, radical hysterectomy, and history of pelvic irradiation. The two common sites of injury are where the distal ureter lies close to the uterine artery, uterosacral ligaments or the vaginal cuff, and where the ureter crosses the pelvic brim at the base of the infundib-ulopelvic ligament. During laparoscopy, the ureter is injured most frequently adjacent to the uterosacral ligaments. The standard approach is to enter the retroperitoneum by opening the round ligament, advance through the loose areolar tissue on the lateral pelvic wall between the peritoneum and the iliac vessels, and identify the ureter attached to the pelvic peritoneum.