4 tips to avert ureteral injury

Kudos for the excellent round table, “ Avoiding lower urinary tract injury “ moderated by Dr. Mickey Karram (September). As Dr. Geoffrey Cundiff pointed out in that article, visualizing the ureter and confirming its integrity at the end of the procedure prevent injury and allow early recognition if it occurs. I ’ d like to add 4 suggestions:

1. Elevate the infundibulopelvic ligament, turning potential space between the vessels and ureter into actual space, and place clamps with the ureter in view.
2. Remember that the ureter runs along the posterior leaf of the pelvic peritoneum.
3. Sharply dissect the bladder downward before placing the clamp on the uterine artery to obtain lateral displacement of the ureter.
4. Document in the operative report your visualization and efforts to identify the ureter.

William J. Mann Jr, MD
Neptune, NJ