Care of the ureter in pelvic surgery

Maintaining the integrity of the ureter is crucial in pelvic surgery. The ureter is best safeguarded by routine intraoperative exposure, which will also allow immediate recognition of injury to it. If doubts over possible injury persist, it is best to open the bladder. The flux of urine from the ureteric orifices or the retrograde passage of catheters will then confirm or deny clinical suspicions. If specialist help is unavailable, the pelvic surgeon must be able to perform simple ureteric repairs or temporize in a way that allows the safe delay of definitive surgery. End-to-end ureteric anastomosis and ureteroneocystostomy are straight-forward procedures that all pelvic surgeons should be familiar with. If they cannot be performed safely, the situation may be salvaged by draining the proximal ureter through the lateral abdominal wall; later, definitive surgery can be performed.