What is Commonest cause of ureteric injury during surgical operation in: and explain in detail?
(Hysterectomy): Ref: 1312-LB, 2275-SB (1292-B & L 25th)Ureteric injury during operations* The most common cause of injury to the ureter is surgical trauma during hysterectomy or other pelvic surgery* Preoperative catheterization of the ureter makes them easier to identify during surgery* Injuries discovered at the time of surgery should be repaired immediatelyMethods for repairing a damaged ureter* If there is no loss of length - Spatulation and end to end anastomosis without tension* If there is little loss of length - Mobilise kidney, psoas hitch of bladder Boari operation* If there is marked loss of length - Transureterostomy- Interposition of isolated bowel loop or mobilized appendix- Nephrectomy* Injuries to the lower third of the ureter - procedure of choice is reimplantation in to the bladder combined with psoas - hitch procedure to minimize tension on the ureteral anastomosis* Midureteral injuries - can be managed with primary ureteroureterostomy, if there is not a significant loss of viable ureter between the proximal and distal sites of injury, other wise transureteroureterostomy is a good option.* Upper ureteral injuries: - are best managed by primary uretero ureterostomy. If there is extensive loss of the ureter, autotransplantation of the kidney and transposition of bowel to replace the ureter are potential surgical options.