Forty-eight cases of ureteral injuries resulting from obstetric gynecologic surgery were treated at the University of Nigeria Teaching Hospital between January 1978 and December 1987. Cesarean sections and cesarean hysterectomies were the leading causes of injury, being responsible for 18 (38%) and 12 (25%) of the cases, respectively. Ureteral transection was the commonest lesion observed, being noted in 29 (60%) of the patients. Attempt was made to reimplant the ureter into the bladder whenever possible, thus ureteroneocystostomy was performed in 27 (56%) cases while only 3 cases of end to end anastomosis were done. There was a case of mortality recorded from one of the referred patients. Forty patients recovered normal renal function after repair. Repair of ureteric injury as soon as the patient is fit for surgery is recommended.

Thirty-eight out of 44 patients with unrepairable urinary and rectal vaginal fistulae obtained good to excellent results from diverting the urine by uretero-colic anastomosis. The patients who hitherto were regarded as social outcasts became integrated into society once again.Intestinal conduits are generally not employed for urinary diversion, because of the social dislike for colostomies and ileostomies, coupled with the lack of availability of the necessary external appliances, in Nigeria. In spite of the good results recorded, it is felt that urinary diversion by uretero-colic anastomosis for vesico-vaginal fistulae should be regarded as the last resort; there are well-known adverse complications from the operation, coupled with psychological trauma to the patients because of their inability to micturate in the normal fashion.Key words: remedial urinary diversion, social outcast, unrepairable urinary vaginal fistulae.

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