Gorovitz & Borten, P.C.
Attorneys at Law

550 Cochituate Road, Suite 25
Framingham, Massachusetts
Tel: (781) 890-9095
Ureteral Injuries
Injury to the ureter is one of the most serious complications associated with
gynecologic surgery. Gynecologists should be skilled in the prevention and
early detection of ureteral injuries and, when the need arises, be prepared to
consult with surgeons with specialized skills in this area (urologist).
Notwithstanding the possibility of injury to the ureters, such injury to the
ureter should be identified before the operation is concluded and immediately
repaired. If the gynecologist does not posses the required training in
repairing an ureteral injury, an intraoperative consultation with a urologist to
perform the ureteral repair is mandatory.

The close anatomical association between the ureters and the female
reproductive organs is well known to any surgeon operating in the abdomen
and pelvis of a woman. Working knowledge of the location of the ureters at all
times during a surgical procedure is essential to prevent their injury. It is a
well know and accepted fact that injury to the ureter at the time of a
gynecologic operation performed through the abdomen can be almost
completely avoided by the simple preliminary measure of routine identification
of the ureters above the level of disease as the initial step in every abdominal
hysterectomy. The principles that contribute to the safety of the ureter in all
pelvic procedures include: adequate exposure of the surgical field;
appropriate dissection of the retroperitoneal spaces; clamping and suturing
under direct vision.

The most common Injuries to the ureter are:

  • Crushing injury from misapplication of a surgical clamp
  • Ligation with a suture
  • Partial or complete transection
  • Pulling angulation of the ureter with subsequent obstruction
  • Resection of a portion of the ureter
  • Ischemia from stripping of the ureteral sheet
  • Ischemia from electrocoagulation of the ureteral circulation

The most specific way of preventing ureteral injury during a pelvic laparotomy
is to identify the ureters as they enter the pelvis over the bifurcation of the
common iliac arteries and to trace the pelvic course of each ureter during the
retroperitoneal dissection of the pelvic sidewalls. It is an accepted fact that
surgeons who do not have sufficient knowledge of the pelvic anatomy to
practice routine and constant identification of the ureter should not be
operating in the pelvis.

Most ureteral injuries are preventable, identifiable and treatable at the time of
the abdominal or pelvic surgical procedure if the surgeon and/or surgical
assistant performs the proper and required dissection and identification of
the ureters before cutting and suturing the tissues which contained the left
ureter. Eventhough an injury to the ureter at the time of abdominal
hysterectomy can occur regardless of the experience of the surgeon, proper
identification of the ureters at the time of the surgical procedure allows:

  • the prevention of an ureteral injury
  • the ureteral injury to be recognized
  • immediately repaired to obviate further complications or the need for a
    subsequent operative procedure or in the alternative can lead to the
    formation of a genitourinary fistula.

The proper dissection of the ureters at the time of the abdominal gynecologic
procedure greatly decreases (even to the degree of eliminating) the chances
of sustaining an ureteral injury (complete transection of the ureter) during a
surgical procedure. During abdominal procedures, the ureters should be
identified visually. Once the ureters are identified, they should be retracted
gently from the operative field. Failure to properly visually identify the ureters
during the abdominal hysterectomy and retract them from the operative field
is a clear deviation from the acceptable standard of care.

Some indications for the surgical procedure (large uterine fibroid(s)), should
alert the operating surgeon that an enlarged uterus is associated with a
distortion of the normal pelvic anatomy. As such, it became mandatory for the
operating surgeon and his assistant to identify the ureter before any tissues
are cut and/or sutured as part of the abdominal or pelvic surgical procedure.
Failure to do so is a clear deviation of the acceptable standard of care for a
gynecologist performing and/or assisting in the performance of an abdominal
and/or pelvic surgical procedure and increases the chances for injury to the
ureter to occur.

The failure of a surgeon (or assistant) to timely identify that a ureter had
sustained an injury (complete or partial  transection) before completing the
abdominal or pelvic surgical procedure and closure of the abdominal cavity is
a clear deviation from the acceptable standard of care expected from a
gynecologist performing an abdominal or pelvic surgical operation. Early
detection and repair of intraoperative injuries to the ureter(s) usually can
restore normal function, prevent postoperative complications and possibly
subsequent surgery.
If you believe that you or your loved one have been injured as a result of a
gynecologic error  that was diagnosable, avoidable and/or preventable, you
may have a valid cause of action. The injury may be the result of a medical
provider's mistake in handling your gynecologic condition and the result of
medical negligence.
Dr. Borten has over 35 years of experience as a
gynecologic surgeon to fully evaluate the merits of your potential case. Allow
the medical malpractice attorneys at Gorovitz & Borten help you assert your
rights and get the compensation you deserve.
Contact Information
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(when possible), please contact us by phone, fax or e-mail with your question
or concern.

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