Every surgeon dreads it. You are in the middle of a procedure and progress stalls. The tissue does not cooperate, the anatomy fights back, and the textbook plan no longer applies.
Urology has time-tested bailouts
In urology we have well-established bailout strategies. When the lower urinary tract is obstructed, we place a urethral or suprapubic catheter and exit safely. When the upper urinary tract is obstructed, we place a stent (a thin tube that keeps the ureter open) or a nephrostomy (a tube that drains the kidney through the skin), exit, and regroup.
What I have learned over the years is that knowing how to exit safely is as important as knowing how to operate.
Two recent cases
In the first case, the ureter remained too narrow despite previous stenting. Instead of forcing a definitive repair under poor conditions, we placed a stent, closed safely, and are now replanning the definitive procedure on our terms, not the anatomy’s.
In the second case, a stent that had been in place for about two months was firmly stuck. Breaking it up piece by piece with the laser did not clear it. Instead of escalating the risk in the moment, we left the remaining fragment, placed a second stent to support the ureter, and planned a fresh CT scan ahead of a combined definitive approach.
Stopping was the sound decision
I do not count either case as a failure. Both were examples of sound surgical judgment.
My lesson for younger surgeons is that a good operation is one you finish safely. Sometimes the bravest decision in the operating room is to stop, stabilise, and come back stronger.
Surgery rewards patience as much as skill.