The most common cause of iatrogenic injuries to the ureter (75%) is a gynecological or surgical pelvic procedure. The diagnosis of ureteral injuries is delayed in 66% (after days or weeks). Lack of hematuria is an unreliable sign to exclude injury, since 30% of all ureteral injuries do not even demonstrate microscopic hematuria or classic clinical symptoms and signs. In view of this, the diagnosis must be one of suspicion and further evaluations are mandatory in all cases of penetrating or blunt abdominal injuries. The most accurate diagnostic tools are CT scan with delayed excretory images and retrograde ureterography, which can also be used to guide stent placement. Low-grade injuries can be sufficiently treated with urinary diversion by PCN drainage or endoscopic ureteric stenting. The treatment of high-grade injuries depends on the localization and extent of the damage. The principles of repair include débridement, spatulation, lack of tension, stenting, postoperative drainage, and a watertight anastomosis with fine nonreactive absorbable suture. A delay in diagnosis is the most important factor contributing to the morbidity of ureteric injuries, and early treatment can reduce the complication rate to below 5%.

Objectives: To study surgical technique and results of treatment in patients receiving surgery for renal carcinoma or Wilm's tumour with extension into the vena cava. Methods: During the period 1993–98, altogether 15 patients received surgery. The investigation was retrospective. All patients were followed until death or at follow-up examination in December 2004. Results: A transverse laparotomy incision was used in 12 patients and a longitudinal incision in three. Two patients were primarily regarded as inoperable. Cardiopulmonary bypass was applied in one patient. At follow-up five patients were alive from 49 to 82 months postoperatively. The other 10 had died between two and 30 months after surgery, eight from carcinoma and two from other causes. Conclusion: In conclusion, involvement of the vena cava does not in itself indicate a dismal prognosis in patients with renal carcinoma. The tumour can usually be removed from the vena cava using exposure depending upon the extent of the tumour proximally into the vena cava.