Iatrogenic ureteral injury: aggressive or conservative treatment

Many different approaches are advocated for management of iatrogenic (operative) ureteric injury. We herein report our experience with 28 ureteral injuries in 26 patients. In six patients, seven injuries were recognized at the time of the initial operation; four end-to-end anastomoses and three ureteroneocystostomies were successfully performed. In 20 patients the diagnosis of injury was delayed. In 14 of them a ureteroneocystostomy with or without Boari bladder flap was performed. The other six patients were first treated by percutaneous nephrostomy, which was successful in only two cases. The other four needed subsequent operative management. The main point that has emerged from our review is that early definitive operative repair is both feasible and preferable.