Value of proximal diversion and ureteral stenting in management of penetrating ureteral trauma.

Cases of penetrating ureteral trauma (17 gunshot wounds and 4 stab wounds) seen at two New York City hospitals over a nine-year period were reviewed. Early urologic complications (defined as urine drainage from the wound for greater than 2 weeks or need for a second operation) occurred in 50 percent of patients with a proximal ureteral injury but were less common when a nephrostomy and stent were used in the repair. A similar beneficial effect of stenting was seen in published cases, with a 91 percent complication rate for unstented repairs and a 15 percent rate when stenting and nephrostomy drainage were both used. The effect of stenting on midureteral repairs was less obvious, but the rate of urologic complications was lower in stented cases. None of the patients with distal ureteral injuries suffered a urologic complication. Stenting with and without a nephrostomy tube also produced good results in 2 patients with proximal ureteral injuries diagnosed late. We conclude that repair of penetrating ureteral injuries should include stenting and nephrostomy tube drainage in cases of proximal injuries, as well as generous debridement and water-tight closure. Midureteral injuries accompanied by gastrointestinal, pancreatic, and major vascular injuries should be stented and proximal diversion considered when prosthetic materials are used for vascular repairs.