Iatrogenic ureteral injuries

Iatrogenic injury to the urinary tract can be caused by any surgeon operating in or around the pelvis and the retroperitoneal abdominal space, with a general incidence of 0.3–1.5%. This includes gynaecologists, general surgeons, urologists, vascular surgeons, neurosurgeons and orthopaedic surgeons. In addition, the impact of technological advances within the surgical field, such as the use of laparoscopy for general surgical and gynaecological procedures, and the application of endoscopic approaches to urological disease increases such injuries.The urinary tract is extremely vulnerable to intraoperative injury for a variety of reasons. Operating in a hostile environment, such as that encountered with repeat surgery, significant inflammation and a large neoplasm, puts the urinary tract at even greater risk. Injuries to the ureter are the most common, because the ureter is similar in appearance to vascular structures, is difficult to identify as a result of its close adherence to the posterior peritoneum, and can be encountered at virtually any level in the retroperitoneum and upper pelvis. When these points are considered along with the inherent difficulties with the occasional unexpected congenital anomaly, such as ureteric duplication or retrocaval ureter, it is easy to understand how vulnerable to injury the ureter can be. Thus it is essential that every surgeon operating in this area must be familiar with the special anatomy of the ureter..