Management of Iatrogenic Ureteral Trauma Post Caesarean Section


  • Prilian Akbaril Satryo Pamungkas Department of Urology Faculty of Medicine Universitas Brawijaya Malang
  • Besut Daryanto Department of Urology Faculty of Medicine Universitas Brawijaya Malang
  • Andri Kustono Department of Urology Faculty of Medicine Universitas Brawijaya Malang



Boari Flap, caesarean section, iatrogenic, psoas hitch, ureteral trauma


Trauma in the ureter occurs in 1-2.5% of all urogenital trauma, and the most common causes of iatrogenic ureteral trauma come from the Obstetrics Gynecology field (59%). One of the causes of delayed diagnosis of ureteral trauma is the lack of operator awareness. This case report described a 29-year-old woman suspected of ureteral trauma after urine-like fluid was found during a cesarean section operation. After 12 days, a clear-yellowish fluid was obtained from the abdominal drain, so the patient was referred to urologists. The abdominal drain produced fluid approximately 250-300cc/24 hours, clear yellow color. IVP and left RPG inferred left distal ureter laceration AAST grade III. Re-exploration, ureteroneocystostomy using Boari Flap technique, and DJ-Stent insertion were done. On the second day postoperative, the abdominal drain production was < 25cc/24 hours in red color. Ureteral trauma is rare, often unnoticed, and often diagnosed late due to a lack of operator alertness.


Download data is not yet available.



Daryanto B, Putra TS, and Satyagraha P. Characteristic of Ureteral Trauma in Tertiary Hospital from January 2005 until December 2016. Journal of Medical - Clinical Research & Reviews. 2018; 2(2): 1-4.

Azmi YA and Renaldo J. Management and Outcome of Urogenital Trauma in Tertiary Hospital: The 8-Year's Experience in Indonesia. Open Access Macedonian Journal of Medical Sciences. 2022; 10(B): 1502-1508.

Lumen N, Kuehhas FE, Djakovic N, et al. Review of the Current Management of Lower Urinary Tract Injuries by the EAU Trauma Guidelines Panel. European Urology. 2015; 67(5): 925-929.

Shapiro R, Fuller K, Wiseman B, et al. Factors in Delay of Diagnosis of Gynecologic Ureteral Injuries at a Rural Academic Hospital. International Urogynecology Journal. 2020; 31(2): 359-363.

Smith AP, Bazinet A, and Liberman D. Iatrogenic Ureteral Injury after Gynecological Surgery. Canadian Urological Association Journal. 2019; 113(6): 51-55.

Smiley LV. Injuries to the Genito-Urinary Tract. Lebanese Medical Journal. 1955; 8(3-5): 260-269.

Gild P, Kluth LA, Vetterlein MW, Engel O, Chun FKH, and Fisch M. Adult Iatrogenic Ureteral Injury and Stricture–Incidence and Treatment Strategies. Asian Journal of Urology. 2018; 5(2): 101-106.

Stewart MN and Hull LW. Ureteral Injuries. The Grace Hospital Bulletin. 1948; 27(1): 47-50.

Phillip H, Okewole I, and Chilaka V. Enigma of Urethral Pain Syndrome: Why are There so Many Ascribed Etiologies and Therapeutic Approaches? International Journal of Urology. 2014; 21(6): 544–548.

Moazin M, Almousa S, Alqasem S, Alhazmi A, Naif aldhaam, and Alfakhri A. Management of Iatrogenic Ureteral Injury: Ureteral Reimplantation with a Bilateral Boari Flap. Urology Case Reports. 2020; 31: 1-3.

Doiron RC and Rourke KF. An Overview of Urethral Injury. Canadian Urological Association Journal. 2019; 13(6): 61-66.

Choi YS, Lee SH, Cho HJ, Lee DH, and Kim KS. Outcomes of Ureteroscopic Double-J Ureteral Stenting for Distal Ureteral Injury after Gynecologic Surgery. International Urogynecology Journal. 2018; 29(9): 1397-1402.






Case Report

Most read articles by the same author(s)