A defect in the lower third of the ureter may result from many pathological conditions, but the most common by far is iatrogenic injury sustained in the course of hysterectomy, when the ureter has been crushed, ligated or divided. As a rule, after several days of obstruction that usually goes unnoticed, the necrotic wall of the injured ureter gives way and urine leaks through the vagina. Even then the diagnosis may be delayed by fruitless manoeuvres with methylene blue, and tampons in tandem, when the most important thing is to make sure that the fluid leaking from the vagina is urine. All that is required to confirm this diagnosis is a “blood urea” test, which can currently be performed on a drop of fluid taken up with a syringe as it pools in the vagina. Since there is no other body fluid with a urea content greater than that of blood, this simple test puts the diagnosis beyond dispute. Action should then follow without delay.
KeywordsCatheter Urea Syringe Flange
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