Penetrating ureteral trauma at an urban trauma center: 10-year experience.

OBJECTIVES: To review the evaluation and management of patients with penetrating ureteral injuries not associated with iatrogenic etiology.
METHODS: A retrospective analysis of 20 patients with penetrating ureteral injuries during a 10-year period at a Level 1 trauma center was performed. Data were collected regarding the mechanism of injury, initial urinalysis and radiographic studies, operative procedure, associated injuries, postoperative complications, and outcome.
RESULTS: In general, patients were young (mean age 27.8 years) men (95%). All injuries were unilateral (14 left and 6 right), were primarily caused by gunshot wounds (95%), and were associated with other injuries (100%). Three injuries were to the proximal ureter, 7 to the middle, and 10 to the distal ureter. Admission urinalysis failed to show gross or microscopic hematuria in 25% of cases. Preoperative intravenous urography (IVU) was diagnostic in 25% of cases. Fifteen injuries were diagnosed intraoperatively, including 2 with diagnostic IVU. Delayed diagnoses were made in 4 cases at 3 to 11 days; two by IVU postoperatively and the other two by computed tomography. All patients were treated surgically by ureteroneocystostomy, ureteroureterostomy, or pyeloplasty. Every repair was stented for a mean of 38 days (range 10 to 72). All three major complications (ureteral stricture, persistent urinary leak, and ureterocutaneous fistula) were managed successfully. Thirteen patients with long-term follow-up demonstrated no evidence of obstruction.
CONCLUSIONS: Ureteral injuries must be considered early during the evaluation of penetrating abdominal injuries. The admission urinalysis may be falsely normal and initial IVU may be nondiagnostic. The diagnosis may be made intraoperatively or be delayed. The surgical repair should be stented, and long-term success can be anticipated.