Three days after total abdominal hysterectomy, a 45-year-old woman develops left flank pain and low grade fever. The abdominal drain is draining clear fluid. Drain fluid creatinine is 42 mg/dL and serum creatinine is 0.9 mg/dL. CT urogram confirms distal left ureteric transection. The most appropriate management is:
- A Nephrectomy of the affected side
- B Immediate open uretero-ureterostomy over a stent
- C Percutaneous nephrostomy followed by delayed ureteric reconstruction ✓
- D Antegrade DJ stenting across the defect as definitive treatment
Correct answer: C. Percutaneous nephrostomy followed by delayed ureteric reconstruction
Explanation
Drain fluid creatinine several times the serum value confirms urine leak from a ureteric injury. When the injury is recognised days after surgery, the field is inflamed and infected, making immediate repair prone to failure. The accepted approach is percutaneous nephrostomy for urinary diversion and control of sepsis, followed by delayed reconstruction such as uretero-neocystostomy or Boari flap at 6 to 8 weeks. Nephrectomy is reserved for a destroyed non-functioning kidney.
Reference: Campbell-Walsh Urology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.