SEVERE injuries to the ureter requiring surgical repair are less rare than is generally supposed. In the past ten years it has been required in 31 patients on the Urology Division at The Brooklyn and Kings County Hospitals. Radical surgery, such as pelvic exenteration, complete hysterectomy, abdominoperineal resections, and penetrating wounds of the abdomen, has contributed to the increased incidence.
Most injuries occur during surgery deep in the anatomic pelvis where exposure is difficult. The point where the ovarian artery crosses over the ureter is a common site of injury. Damage limited to a small segment of 1-2 cm usually results from severing the ureter with a knife or scissors, compressing it with a ligature, or crushing with an arterial forceps. In these instances, the injured area can be resected, the ends spatulated, and joined by an end-to-end anastomosis. This method is particularly suitable when the injury is found during