A patient is seen on the second postoperative day after a difficult abdominal hysterectomy with the injury to left uterine aery pedicle with sepsis. A ureteral injury is diagnosed. If the injury had been recognized at the time of surgery, which of the following procedures could have been recommended?

**Core Concept**
During abdominal hysterectomy, injury to the ureter or its blood supply can occur, leading to ureteral damage. Prompt recognition and management are crucial to prevent long-term sequelae.

**Why the Correct Answer is Right**
In the event of ureteral injury recognized during surgery, the recommended procedure is ureteral repair or reimplantation, often using an end-to-end anastomosis. This involves suturing the cut ends of the ureter together, or reimplanting the ureter into the bladder. The goal is to restore normal ureteral function and prevent complications such as stricture, fistula, or chronic kidney damage.

**Why Each Wrong Option is Incorrect**
**Option A:** Primary closure of the ureteral injury is generally not recommended, as it may lead to stricture formation and ureteral obstruction.

**Option B:** Ureteral stenting alone may not be sufficient for repair, as it does not address the underlying injury and may not prevent long-term complications.

**Option C:** Ureteral resection with excision of the injured segment is not typically recommended, as it can lead to significant loss of ureteral length and potential need for a more complex reconstruction.

**Clinical Pearl / High-Yield Fact**
In abdominal hysterectomy, the ureters are at risk of injury due to their close proximity to the uterine arteries. A high index of suspicion and prompt recognition of ureteral injury are essential to prevent long-term complications.

**Correct Answer: C. Ureteral resection with excision of the injured segment is generally not recommended.**

✓ Correct Answer: C. Ureteral reimplantation into the bladder