Laparoscopic repair of ureteral injuries

STUDY OBJECTIVE: To assess the outcome of laparoscopic repair of pelvic ureter injuries. DESIGN: Retrospective case series (Canadian Task Force classification II-2). SETTING: Large urban tertiary care medical center. PATIENTS: Four women who had pelvic ureter injuries and laparoscopic repair during laparoscopic gynecologic procedures. INTERVENTION: Laparoscopic ureteroureterostomy. MEASUREMENTS AND MAIN RESULTS: All injuries were identified immediately and repaired laparoscopically. No patient required repeat surgery. On assessment by physical examination, serum creatinine, and intravenous urogram, no patient had evidence of renal insufficiency. One woman had a narrowing at the site of ureteroureterostomy 6 weeks after repair; it was resolved on urogram 8 months after the injury. CONCLUSION: Laparoscopic ureteroureterostomy is feasible in some cases of ureteral injury. Experience with laparoscopic suturing is necessary to perform this procedure.     

Laparoscopic Ureteral Reimplantation for the Management of Long-segment Ureteral Defect in Gynecologic Surgeries

ObjectiveTo demonstrate techniques of laparoscopic ureteral reconstruction for long-segment ureteral defects in gynecologic surgeries.DesignStep-by-step demonstration of a laparoscopic ureteral reimplantation using the Boari flap and ileal interposition.SettingGynecologic diseases often involve the ureter; hence, knowledge of ureteral reconstruction techniques is imperative in gynecologic surgeries. The important aspect of ureteral reconstruction is to ensure tension-free anastomosis; therefore, various methods are required depending on the length of the ureteral defect [1]. The Boari flap and ileal interposition are preferred for repairing 8-cm to 12-cm and >12-cm ureteral defects, respectively. These methods have traditionally required large incisions [2,3]. Laparoscopic ureteral reimplantation using the Boari flap and ileal interposition has been reported to be as safe as the open technique and superior in terms of postoperative recovery in urologic surgeries [3,4]; however, to the best of our knowledge, it has not been reported in the field of gynecology.To our knowledge, this is the first report to demonstrate the techniques of laparoscopic Boari flap and ileal ureter replacement in gynecologic surgeries. The technique was approved by our institutional review board.InterventionsThe first case involved an intra-abdominal desmoid tumor, whereas the second case involved recurrent endometrial cancer. In both cases, long-segment ureteral resection was required to achieve complete tumor clearance. Laparoscopic ureteral reimplantation was performed successfully, without any complications, using the Boari flap in the first case and ileal interposition in the second.ConclusionLaparoscopic ureteral reimplantation is technically feasible for the management of long-segment ureteral defects.     

Laparoscopic ureteroneocystostomy with psoas hitch

BACKGROUND AND PURPOSE: Laparoscopic extravesical ureteroneocystostomy is an infrequently described technique. Our aim is to describe five cases where we used the intracorporeal freehand suturing technique successfully for performing laparoscopic extravesical transperitoneal ureteral reimplantation with psoas hitch. We describe the preliminary results of these cases. PATIENTS AND METHODS: We performed this surgery in five female patients. Two patients had a low ureterovaginal fistula after total laparoscopic hysterectomy. The other three patients had undergone laparoscopic radical hysterectomy. RESULTS: The average surgical time was 220 minutes. The average blood loss was 150 mL. The average stay was 3 days, and the average time to starting oral intake was 12 hours. No intraoperative or postoperative complications occurred. The urinary catheter was removed after 3 weeks and the double j stent after 6 weeks. Follow-up urography showed good clearance of the kidney and ureter. There was no reflux on the postoperative cystogram. CONCLUSION: Laparoscopic extravesical ureteroneocystostomy with intracorporeal freehand suturing technique and psoas hitch is a feasible procedure in females for managing ureterovaginal fistulas after laparoscopic gynecologic surgeries. The patients need not be subjected to open surgery because this complication can be repaired laparoscopically, thus minimizing the morbidity.     

Laparoscopic management of complications in gynecologic laparoscopic surgery: a 5-year experience in a single center

Study ObjectiveTo evaluate the feasibility and efficacy of laparoscopic management of complications without conversion to laparotomy in gynecologic laparoscopic surgery.DesignRetrospective clinical study (Canadian Task Force classification III).SettingUniversity teaching hospital.PatientsA total of 2668 women who underwent gynecologic laparoscopic surgeries from March 2003 through February 2008.InterventionsGynecologic laparoscopic surgeries.Measurements and Main ResultsWe investigated major complications during gynecologic laparoscopic surgery. Based on patients’ medical records, we reported types of laparoscopic surgery, types of complication, early recognition of complications, and treatment method of complications. Overall, 33 (1.24%) complications occurred in this study. There were 18 (0.67%) bladder injuries, 6 (0.22%) major vessel injuries, 3 (0.11%) bowel injuries, 3 (0.11%) ureteral injuries, 2 (0.07%) diaphragmatic injuries, and 1 (0.04%) intravesical foreign body. In all, 32 of 33 complications were successfully repaired laparoscopically. In 1 case, rectal perforation occurred on the third day after surgery; Hartmann operation followed by colostomy reversal was performed.ConclusionLaparoscopic management of complications in gynecologic laparoscopic surgery is feasible and efficient.     

Management and Outcome of Rectal Injury During Gynecologic Laparoscopic Surgery

ObjectiveTo assess the incidence and management of accidental rectal injury during gynecologic laparoscopic surgery.DesignA retrospective study with review of outcomes (Canadian Task Force classification II-3).SettingA tertiary care/research/university hospital.PatientsPatients with colon injury during laparoscopy for gynecologic diseases at Samsung Medical Center, Seoul, Korea, from January 2000 to April 2012.InterventionUse of absorbable suture or staples in primary repair of injured colon.Measurements and Main ResultsFrom January 2000 to April 2012, 12 354 patients underwent laparoscopic surgery. Rectal injury occurred in 15 women (0.12%). Their median age was 42.5 years (30–49), and the median length of injury was 3 cm (0.7–7). Among 13 patients with rectal injuries recognized during surgery, 10 patient injuries were repaired primarily with interrupted absorbable sutures without converting laparotomy, 1 patient underwent laparoscopic low anterior resection with Endo-GIA, 1 underwent open primary repair, and 1 underwent open low anterior resection. Two rectal injuries were detected after surgery. One of these patients underwent primary repair under laparotomy at day 4 after surgery. The other patient had development of a rectovaginal fistula requiring open segmental resection 30 days after primary laparoscopy despite conservative management, including percutaneous drainage and prophylactic antibiotics.ConclusionRectal injury during laparoscopy in the gynecologic field can be repaired successfully without the need for a colostomy regardless of mechanism of injury and the size of injury if adequate rectal tissue is available and recognized during surgery.     

Ureteral injury in gynecologic surgery: A ten-year review in a community hospital

Objective: Our purpose was to review and analyze ureteral injuries incidental to gynecologic surgery in a community hospital.Study design: During the study period from Jan. 1, 1983, through Dec. 31, 1992, all patient records in which ureteral injury resulted from gynecologic surgery were reviewed. The operative procedure, pathologic result, location of injury, and type of repair were studied. Additionally, the time of recognition and diagnostic methods in these ureteral injuries were analyzed.Results: Nineteen ureteral injuries were incurred during the performance of 4665 gynecologic surgical procedures, an incidence of 0.4%. Patients ranged in age from 23 to 70 years. Recognition of the ureteral injury occurred intraoperatively in 10 patients and was delayed from 1 to 16 days in 9 patients. Six of the ureteral injuries were repaied by end-to-end anastomosis, 3 by deligation, and 10 by ureteroneocystostomy. Immediate postoperative urinary integrity was found in all patients.Conclusion: Gynecologic surgical procedures in this study resulted in a 0.4% incidence of ureteral injury, and repair of these injuries was successful in all cases for the short term. 1995; 172:1817–1822.)     

Late presentation of ureteral injury after laparoscopic surgery

OBJECTIVE: To describe clinical presentation, etiology, and treatment of ureteral injuries recognized late in women who had gynecologic laparoscopies. METHODS: We reviewed the charts of 12 women who had delayed recognition of ureteral injuries between January 1991 and December 1998. RESULTS: Patients presented with fever, hematuria, flank pain, or peritonitis between 3 and 33 days postoperatively. The mechanism of ureteral injuries was electrocoagulation in seven women, laser ablation in one, and stapler ligation in four. The sites of injury were near the inferior margin of the sacroiliac joint on excretory urogram in eight women and near the ureterovesical junction in four. Three women initially treated with internal ureteral stents were subsequently treated with ureteroneocystostomy because of progression of urinary ascites in two and a delayed ureteral stricture in one. In nine patients, attempts at ureteral stenting were unsuccessful and immediate ureteral reconstruction was done. Outcomes were good in all cases. CONCLUSION: Delayed recognition of ureteral injury after gynecologic laparoscopy was associated with serious complications, and initial treatment with ureteral stenting was not useful. We advocate early open repair for those injuries.     

Very Low Rates of Ureteral Injury in Laparoscopic Hysterectomy Performed by Fellowship-trained Minimally Invasive Gynecologic Surgeons

Study ObjectiveThe objective of this case series is to evaluate the rates of ureteral injury at the time of laparoscopic hysterectomy among high-volume fellowship-trained surgeons.DesignA retrospective chart review was performed, evaluating laparoscopic hysterectomy cases between 2009 and 2019 performed exclusively by fellowship-trained surgeons.SettingDivision of Minimally Invasive Gynecologic Surgery (MIGS) at the Brigham and Women's Hospital and Brigham and Women's Faulkner Hospital, a Harvard Medical School teaching hospital in Boston.PatientsAll patients undergoing laparoscopic hysterectomy by one of 5 surgeons with fellowship training in MIGS.InterventionsNone.Measurements and Main ResultsA total of 5160 cases were handled by MIGS surgeons between 2009 and 2019 at our institution. Of these cases, 2345 were laparoscopic hysterectomy cases with available intraoperative and postoperative documentation. Most patients had undergone previous surgeries, and the most common indications for hysterectomy included uterine myomas, pelvic pain/endometriosis, and abnormal uterine bleeding. At the time of hysterectomy, 1 ureteral injury (0.04%) was noted. No additional delayed ureteral injuries were observed. Most patients were discharged home the same day (64.9%) and did not have any postoperative complications (63.9%) as designated by the Clavien-Dindo classification.ConclusionUreteral injury, although rare, is more prevalent in gynecologic surgery than in other surgical disciplines that have some focus on the pelvis. No study to date has evaluated the effect of surgical training and volume on rates of ureteral injuries. This study retrospectively examined ureteral injury rates for one group of high-volume fellowship-trained surgeons and found their rates to be lower than the national average. Proposals are presented for optimizing training and delivery of gynecologic surgical care to minimize complications.     

Laparoscopic Ureteroureteral Anastomosis for Distal Ureteral Injuries during Gynecologic Laparoscopic Surgery

Study ObjectiveTo estimate the feasibility and surgical outcomes of laparoscopic ureteroureteral for treatment of distal ureteral injuries.DesignRetrospective clinical study (Canadian Task Force classification II-2).SettingUniversity teaching hospital.PatientsFour women with ureteral transection or ureterovaginal fistula.InterventionLaparoscopic ureteroureteral .Measurements and Main ResultsMedian age of patients was 44 (range, 33–63) years, and median operating time was 110 (range, 85–150) minutes. There were no conversions to laparotomy. No intraoperative or postoperative complications occurred. Follow-up ranged from 20 to 46 months. All patients have been asymptomatic, and follow-up intravenous pyelograms and ultrasound examinations have been normal.ConclusionLaparoscopic ureteroureteral anastomosis is an alternative surgical option in women with distal ureteral injuries during gynecologic laparoscopic surgery.     

妇产科盆腔手术中输尿管损伤96例分析

目的 :探讨妇产科盆腔手术中减少及避免输尿管损伤的措施。方法 :回顾分析妇产科盆腔手术所致输尿管损伤 96例的临床资料。结果 :术中及时发现和术后 4 8h内明确诊断 5 6例 ,均Ⅰ期修复成功 ;术后延迟诊断明确 4 0例 ,除 2例行肾切除术、1例死亡外 ,37例经暂时性尿流改道后 ,Ⅱ期修复成功。结论 :手术野渗液多 ,输尿管扩张 ,术后腰腹疼痛 ,不明原因发热伴切口渗液 ,无尿或腹腔积液等应考虑输尿管损伤的可能。术前充分准备 ,进行相关检查 ,术中分清解剖关系 ,细心操作 ,术后密切观察是防治输尿管损伤的关键     

A new portal for gynecologic laparoscopy

We used the middle upper abdomen as a primary port insertion as an alternative portal for laparoscopy and multiport operative pelviscopy in 188 women who were at high risk for subumbilical adhesions because of previous abdominal surgeries or history of gynecologic cancer. Primary cannula insertion was in the middle upper abdomen between xyphoid process and umbilicus (Lee-Huang point). This was the single entry site for the Veress needle and primary laparoscopy port. In 184 (98.4%) of 188 women surgery was performed without complications. No procedure was converted to laparotomy due to visceral or vascular injuries. Two omentum injuries from primary port insertion were repaired with bipolar electrocoagulation; a colon injury was repaired with laparoscopic sutures. In our experience, this laparoscopic port is effective in women who have had abdominal surgery or gynecologic malignancy. (J Am Assoc Gynecol Laparosc 8(1):147-150, 2001)     

腹腔镜妇科恶性肿瘤淋巴结清扫术中并发症及处理

腹腔镜下的盆腔和腹主动脉旁淋巴结切除术以其干净、彻底、视野暴露充分、出血少而著称,在妇科三大恶性肿瘤的手术中应用的越来越广泛,但其相关并发症尤其是术中静脉的损伤并未减少,补救的方法与传统开腹手术有所不同。腹腔镜手术中出现的静脉损伤绝大多数可在镜下得到及时有效的修补,无需中转开腹进行修补。补救的方法有直接缝合法和止血材料外加后腹膜缝合加压固定法。     

Major complications of operative and diagnostic laparoscopy for gynecologic disease

STUDY OBJECTIVE: To compare complication rates of diagnostic and operative laparoscopy. Design. Retrospective study (Canadian Task Force classification II-2). SETTING: One medical center and three teaching hospitals. PATIENTS: Six thousand four hundred fifty-one women with various indications for laparoscopic diagnosis and/or laparoscopic surgery from January 1994 through June 1999. INTERVENTION: Diagnostic and operative laparoscopies. MEASUREMENTS AND MAIN RESULTS: Forty-two major complications occurred that directly resulted in one death. One patient had stomach injury, 3 had major vessel injuries, 5 had ureter injuries, 10 had intestinal injuries, and 23 had bladder injuries. The overall complication rate for all laparoscopies was 0.65% (42/6451); however, it rose to 0.80% (39/4865) for operative laparoscopy compared with 0.19% for diagnostic laparoscopy (3/1586; p <0.001, Fisher's exact test). CONCLUSION: Laparoscopic surgery is appropriate for managing various gynecologic diseases and has an acceptable complication rate. However, operative laparoscopy should be performed carefully because its rate of complications is significantly higher than that of diagnostic laparoscopy, especially for laparoscopic-assisted vaginal hysterectomy. (J Am Assoc Gynecol Laparosc 8(1):68-73, 2001)     

A review of laparoscopic ureteral injury in pelvic surgery

The objective of this study was to review the body of literature in reference to ureteral injury during laparoscopic surgeries and to determine: 1) the reported rates of ureteral injury; 2) the initial laparoscopic surgeries during which ureteral injury occurred; 3) the time of injury recognition (intra- versus postoperative); 4) the type, 5) the location, and 6) the mode of injury repair; and 7) the surgical laparoscopic instruments involved in ureteral injury.The appropriate medical subject heading (MSH) terms were selected and used in a search of the Medline computerized database and the online American College of Obstetricians and Gynecologists database. World literature published in the English language on ureteral injury during laparoscopic surgery between 1966 and 2003 was reviewed.A total of 70 reported instances of ureteral injury during laparoscopic surgery were identified among 2491 reported cases in which ureteral laparoscopic complications were discussed. Incidences of injury ranged from <1% to 2%. These 2491 cases of laparoscopy were presented as a mixed group, which included case reports, small series of studies, as well as longer, consecutive studies. In 18 of the 70 (25.7%) cases, the initial laparoscopic procedures during which ureteral injury occurred were not described or specified. In cases in which the type of laparoscopic surgery was specified, 14 of the 70 (20.0%) total cases of ureteral injury occurred during laparoscopically assisted vaginal hysterectomy (LAVH). Ureteral injury was identified intraoperatively in 6 of 70 (8.6%) cases, postoperatively in 49 of 70 (70.0%) cases, and, in 15 of 70 (21.4%) cases, the time of diagnosis was not specified. In 36 of the 70 (51.4%) reported injuries, the type of injury was not specified or described. In instances in which the types of injury were described, transection occurred most commonly, accounting for 14 of 70 (20.0%) injuries. The location of ureteral injury was not specified in 46 of the 70 (65.7%) cases. When location was specified, injuries most often occurred at or above the pelvic brim, accounting for 10 of the total 70 (14.3%). Electrocautery was involved in 17 of the 70 (24.3%) cases of ureteral injury, but in 34 of the 70 (48.6%) cases, the surgical laparoscopic instrument involved was not reported. A laparotomy was used to repair the ureteral injury in 43 of 70 (61.4%) cases.Ureteral injuries reported in peer-reviewed journals often lack detailed presentation of the initial laparoscopic surgeries during which ureteral injury occurred, or of the type, the location, and the instrumentation involved in ureteral injury. A high incidence of ureteral injury was found among the laparoscopic procedures analyzed in this review. Laparoscopically-assisted vaginal hysterectomy was the leading procedure in which injury occurred, and instruments involved in electrocoagulation were associated with the most injuries incurred during laparoscopic surgery.     

Laparoscopic repair of ureteral injuries

STUDY OBJECTIVES: To evaluate the laparoscopic approach for repairing ureteral injuries, and assess the effect of ureteral dissection (ureterolysis) on tissue healing. DESIGN: Randomized animal study (Canadian Task Force classification I). SETTING: Biological Resources Unit, Cleveland Clinic Foundation. SUBJECTS: Ten pigs. INTERVENTION: In all animals, the pelvic segment of the right ureter was completely dissected off the pelvic sidewall and peritoneum. In group A, both pelvic ureters were divided with scissors and repaired over a stent; in group B the ureters were coagulated and anastomosis was performed after resection of the necrotic segment. Laparoscopic intracorporeal suturing techniques were used for end-to-end ureteral anastomosis. MEASUREMENTS AND MAIN RESULTS: All animals survived without complications. Ureteral stents were removed 4 weeks after repair. Creatinine level and retrograde pyelogram performed before injury and 12 weeks after repair were compared. At necropsy anastomoses were evaluated for leak, pressure flow studies, and histopathology. All anastomoses were patent with no leak. Although serum creatinine level increased significantly after repair (p = 0.001), this increase never reached levels found in renal failure, and all animals continued to do well and have good appetite (mean increase in body weight 20.3 +/- 6.2 kg). Mild hydronephrosis was diagnosed in three kidneys, all on the right side. Mild ureteral dilatation occurred bilaterally; it was significant on the right side (3.8 +/- 3.8 mm, p = 0.05) but not on the left (1.7 +/- 2 mm, p = 0.3). Results of pressure flow studies did not reveal significant obstruction at anastomoses. Healing around the dissected right ureter was marked with dense fibrosis, adhesions, and scar formation. On histopathology the right ureter showed more urothelial abnormalities than the left, with marked fibrosis and sclerosis in the muscularis and adventitial layers. CONCLUSION: Ureterolysis may interfere with the healing process of ureteral injuries by increasing fibrosis and adventitial scarring. Laparoscopic repair of these injuries is feasible and safe.     

Value of ureteral catheterization in laparoscopy]

OBJECTIVE: Describe indications and procedures of ureteral retrograde catheter placement in operative laparoscopy. Assess the security that allows this technique to avoid or detect ureteral injury. STUDY DESIGN: A cohort study over a five year period was performed on 1722 patients who underwent an operative gynecologic laparoscopy. SURGICAL TECHNIQUE: When presumptive evidence of ureter adhesiolysis (dense adhesions from previous surgery, endometriosis), or suspicion of iatrogenic ureter transection, laparoscopic procedure was interrupted. A cystoscopy was performed and an internalized stent was inserted. RESULTS: In nine cases (preventive indications), patients required this procedure in adnexal surgery (dense adhesions from previous operations endometriosis), in oophorectomy for residual ovary syndrome and ovarian remnant syndrome and in hysterectomy with an intraligamentary leiomyomata. In one case (diagnostic indication), ureteral catheter placement was performed after use of an endoscopic linear stapler during a laparoscopically assisted vaginal hysterectomy. CONCLUSION: This intra-operative procedure can allow better ureter recognition and its safe dissection when complex operative laparoscopy is foreseen.     

Urgent Laparoscopic Surgeries during the Third Trimester of Pregnancy: A Case Series

Study ObjectiveLaparoscopic management of nonobstetric acute abdominal pain in the third trimester of pregnancy remains controversial with limited data regarding procedure safety and feasibility. This study aimed to investigate the feasibility, immediate complications, and short-term outcomes of laparoscopic surgery at an advanced gestational age.DesignCase-series.SettingSheba Medical Center, a tertiary referral center.PatientsPregnant women who underwent urgent laparoscopic surgery at 27 weeks of gestation and above.InterventionEmergent laparoscopic surgery.Measurements and Main ResultsClinical data were retrospectively collected and analyzed. A telephone questionnaire was administered in cases of missing data. Clinical information obtained included detailed medical and obstetric history; preoperative, intraoperative, and postoperative data; complications; and pregnancy outcomes. Between January 2010 and July 2017, 12 patients underwent emergent laparoscopic surgeries during the third trimester of pregnancy. The gestational age at the time of the surgery ranged between 27 and 38 weeks. All women had singleton pregnancies. Laparoscopic surgeries included 7 appendectomies, 4 adnexal surgeries, and 1 diagnostic laparoscopy. No complications related to the access route for any of the 12 laparoscopic surgeries occurred. The laparoscopic surgical procedure was successfully completed in 11 patients; only 1 laparoscopic appendectomy for perforated acute appendicitis with purulent peritonitis at 30 weeks of gestation was converted to laparotomy because of a limited operative field. Two patients had preterm labor at 35 and 36 weeks of gestation, respectively. None of the women was complicated with intrauterine fetal demise or low Apgar scores.ConclusionOur results demonstrate that urgent laparoscopic surgeries in the third trimester of pregnancy are feasible and can be safely performed with minimal risk for the patient and fetus. Larger prospective studies are required to validate these recommendations.     

Can centralised care of complex laparoscopic procedures prevent urinary tract injuries?

Centralised care of complex laparoscopic procedures offers expertise and multidisciplinary care. The objective was to identify if centralised care makes urinary tract injuries less likely or avoidable. This Retrospective Audit was performed at a Tertiary Referral Centre for Advanced Laparoscopic Surgery in North East England. The incidence of injury to bladder/ureter, time of diagnosis, instrument, location, side and mode of repair were evaluated in 105 consecutive complex laparoscopic procedures. Injuries were identified in three (2.8%) cases. There was one bladder injury which was unavoidable. The bladder dome was opened to allow excision of bladder endometriosis. There were two ureter injuries. The first injury involved the ureter being locked in a vaginal vault stitch. The second injury had stage IV endometriosis with peri-ureteric endometriosis where the anatomy was distorted, with medial displacement and kinking of the ureter secondary to fibrosis at the level of the ureter crossing below the uterine artery, with resultant accidental transection of the ureter close to the uterine artery. The first ureter injury was not a laparoscopic injury but due to vaginal vault closure. Arguably, vault closure in any vaginal hysterectomy could carry the same theoretical risk. The only direct laparoscopic injury was the ureteral transection. Such cases present a challenge due to a higher chance of anatomical distortion and predisposition to urinary tract injury. Noteworthy here is the fact that the ureter injury occurred where there was probable distortion of the anatomy, due to endometriosis, of the ureter at the level of the uterine artery. These cases are tackled by experienced laparoscopic surgeons in tertiary centres, yet injuries still occur. Is it possible then that those injuries represent a minimum unavoidable injury rate, and are they injuries or in fact unavoidable consequences of such inherently dangerous and difficult surgery?     

Ureteral injury in obstetric and gynecologic operations in Nigeria.

Forty-eight cases of ureteral injuries resulting from obstetric gynecologic surgery were treated at the University of Nigeria Teaching Hospital between January 1978 and December 1987. Cesarean sections and cesarean hysterectomies were the leading causes of injury, being responsible for 18 (38%) and 12 (25%) of the cases, respectively. Ureteral transection was the commonest lesion observed, being noted in 29 (60%) of the patients. Attempt was made to reimplant the ureter into the bladder whenever possible, thus ureteroneocystostomy was performed in 27 (56%) cases while only 3 cases of end to end anastomosis were done. There was a case of mortality recorded from one of the referred patients. Forty patients recovered normal renal function after repair. Repair of ureteric injury as soon as the patient is fit for surgery is recommended.