Early surgical management of extensive gynecologic ureteral injuries

Early ureteral reconstruction was performed during the immediate postoperative period upon 12 patients who sustained ureteral injuries secondary to gynecologic surgical procedures. The injuries occurred postoperatively for benign disease: endometriosis in one patient, fibrosis in eight patients and tubo-ovarian abscess in one patient. In three instances, portions of the ureter were noted in the pathologic specimen. After unsuccessful attempts at retrograde catheterization or stenting, all ureteral injuries were explored within three weeks of the primary gynecologic operation. Ureteral reconstruction was successful in all. The advantages of early operative intervention versus endoscopic or delayed operative intervention, or both, are discussed.