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Question 6#

Concerning ureteric trauma, which of the following is true?

A. Retrograde pyelogram is the most sensitive test to detect ureteral injury
B. Bladder mobilization is not integral to repair of ureteric injury
C. Kidney mobilization is not integral to repair of ureteric injury
D. Use of ureteric stents is not useful in predicting post-repair strictures

Correct Answer is A

Comment:

A retrograde pyelogram is the most sensitive test for ureteral injury. Partial injuries can be primarily repaired, although all devitalized tissue must be debrided to avoid delayed tissue breakdown and urinoma formation. Ureteral stents should be placed in this situation to facilitate healing without stricture. Midurethral level injuries can be treated with a ureteroureterostomy if a spatulated, tension-free repair can be achieved. For longer defects, the bladder can be mobilized and brought up to the psoas muscle (psoas hitch). For additional length, a tubularized flap of bladder (Boari flap) can be created and anastomosed to the remaining ureter.