iatrogenic ureter injury

 Iatrogenic  ureter injury

Cause:
1.GU : urteroscopy, open surgery, laparoscopic
2.GYN: hysterectomy
3.CRS: APR, sigmoidectomy

Mechanism:
ligation, clamp, thermal injury, ischemia change, laceration

Diagnosis:
1.seldom noted during operation, always delayed diagnosis(65-80%)
2.sign:flank pain, hematuria, Cr increased, aurea,fever,
3.Image:
     retrograde and antegrade urography
     contrast CT with extravasation


Treatment:
-lower/3 ureter:
     psoas hitch:補3cm
     boari flap:補5cm
--->兩者可補7cm
-middle/3:
     segmental resection:for<1cm injury, 可補3cm
     trans-urtero-ureterostomy

-upper/3:
     free kidney:3cm
     autotransplant