16/05/2026
Sharing my newspaper coverage featuring a challenging case successfully managed by our team.
A 24-year-old lady, Hemlata, came to us after a devastating complication following her first cesarean delivery - an unexpected ureteric injury. On detailed evaluation, we discovered another major challenge: she was also suffering from genitourinary tuberculosis (TB).
Operating in post-surgical TB cases is extremely difficult because inflammation and fibrosis make identification and isolation of the ureter highly challenging. Still, we believed the case could be managed step by step, and we started from scratch.
Initially, we placed an abdominal drain near the bladder to control urinary extravasation and inserted a PCN (Percutaneous Nephrostomy) tube into the kidney so that most of the urine could safely drain externally. The next major challenge was determining the exact extent of ureteric damage. Meanwhile, anti-tubercular therapy (ATT) was started, and the patient was advised to return after 6 weeks.
After reassessment with simultaneous nephrostogram and retrograde pyelography (RGP), we found that nearly 10–12 cm of the lower ureter was severely damaged. Repairing such a long ureteric defect is extremely challenging because the upper ureter cannot simply be brought down to the bladder.
After careful planning, we decided to perform a laparoscopic Boari flap with psoas hitch - a highly advanced reconstructive procedure. This was performed for the first time in Aligarh. In this surgery, we reconstructed a new lower ureter using bladder tissue itself, and successfully restored continuity.
But the journey did not end there. Despite our best efforts, the patient developed a postoperative urinary leak through the drain. Fortunately, we had already prepared for such a possibility. We reopened the previously placed PCN tube to divert urine, gradually managed the leak, applied glue near the newly created ureteric or***ce, and placed a DJ stent across the reconstructed ureter.
After a long and difficult battle, everything finally improved. Seeing the patient smiling and laughing again gave me immense satisfaction and confidence. Together, we overcame one of the most complicated reconstructive urology cases.
This case gives hope to many patients that even severe complications can be managed effectively here in our own city. Earlier, many such patients had no option except traveling to Delhi, where getting timely appointments itself became another struggle. By that time, many patients lose hope emotionally, physically, and financially.
Happy to share one of the most challenging yet rewarding cases of my journey - a case where we gave our absolute best, and together, we won.
