374 Obstetrics and Gynecology Board Review •••
❍ What should be done if IVP shows obstruction or hydronephrosis?
Attempts to pass a ureteral catheter past the point of obstruction should be made. If successful, the catheter should
be left in place for 14 to 21 days. Follow-up IVP should be performed after catheter removal.
❍ What should be done if a catheter cannot be passed past the ureteral obstruction?
Immediate ureteral repair or percutaneous nephrostomy. If percutaneous nephrostomy is performed, the injury
may resolve spontaneously, thus definitive surgery should be deferred for 8 weeks. However, when unintentional
ureteral ligation is performed in a healthy patient and is discovered within 10 to 14 days of surgery, immediate
repair consisting of ureteroneocystostomy can be performed.
❍ How long can an obstructed, uninfected kidney survive?
7 to 158 days.
❍ What is a common cause of litigation in gynecology?
Failure to recognize a urinary tract injury. Patients do quite well with intraoperative urinary tract injury repair, but
suffer tremendously when these repairs go undiagnosed.
REFERENCE
Gilmour DT, Das S, Flowerdew G. Rates of urinary tract injury from gynecologic surgery and the role of intraoperative cystoscopy.
Obstet Gynecol. 2006;107(6):1366–72.