A patient is seen on the second postoperative day after a difficult abdominal hysterectomy with injury to left uterine artery pedicle with sepsis. A ureteral injury is diagnosed. If the injury had been recognized at the time of surgery, which of the following procedures could have been recommended?
Implanting a severed ureter into the bladder is the procedure of choice, especially when the ureteral transection is near the bladder, as would be expected in this case. Following an injury to the ureter during surgery, a drain should be placed extraperitoneally, not intraperitoneally. If a polyethylene catheter is in- serted, it should be placed above the site of injury so that urine is drained before arrival at the site of injury. Ureteroureteral anastomosis should be done only if reimplantation into the bladder is not feasible.
Percutaneous nephrostomy
Placement of a ureteral stent without anastomosis
Ureteral reimplantation into the bladder
Ureteroureteral anastomosis