External ureteral injuries

Introduction: Traumatic ureteral injuries are quite uncommon. Penetrating and non-blunt trauma are the most common cause of ureteral injuries. Most of the blunt ureteral injuries described in the literature are case reports. Simultaneous bilateral ureteral injury is extremely rare. Diagnosis: In homodynamic stable patients imaging studies should be conducted when there is suspicion of urinary tract injury. Abdominal computerized tomography with contrast injection and delayed scans are the gold standard for staging such injuries. Excretory urography may be used when computerized tomography is not feasible. When both of these imaging studies are not diagnostic and there is still a high suspicion of injury, a retrograde pyelography would be the next imaging study option. Management: Partial ureteral transection can be managed with ureteral stent placement. Complete ureteral transection and some grade III injuries should be explored and repaired with debridement, placement of ureteral stent and tension-free anastomosis of healthy ureteral ends with absorbable stitches and omental or peritoneal wrap. The type of anastomosis depends on the height of the ureteral injury and whether the contralateral ureter is existent and with no diseases. Conclusions: A high index of suspicion is needed in diagnosing ureteral injury in patients with blunt or penetrating trauma. Delay in diagnosis or inappropriate treatment would lead to serious immediate and delayed complications, from mild hematoma to abscess, sepsis, strictures, obstructive nephropathy, and renal unit loss.