Management of injuries to the urinary tract

Injury to the urinary tract is one of the major concerns of the gynaecological surgeon during routine gynaecological procedures. Injuries to the ureter in the pelvis tend to occur in association with gynaecological surgery. In the circumstance of a ureteric injury above the pelvic brim, the management where possible is to anastomose the cleanly divided ends of the ureter. The management of the late diagnosed urinary tract damage is mainly the area of expertise of the experienced urologist; the gynaecologist should not delay in calling for a colleague's advice as further delay will seriously risk the function of the kidney. Predisposing factors include: congenital anomalies, including duplex ureters and ectopic kidneys, endometriosis, chronic pelvic inflammatory disease, previous pelvic surgery, gynaecological malignancy, radiotherapy with scarring and compromised blood supply, and retroperitoneal masses such as broad ligament fibroids and large ovarian cysts.