Gunshot injuries to ureter

Diagnosis and management of ureteric injury: an evidence‐based analysis

“…Placing a PCN is usually safer and more universally applicable. Retrograde ureteric stenting is typically unsuccessful (50-95%) and should be attempted only for certain low-grade injuries [13,15,46,49,69,72,100] Antegrade stenting is often successful, particularly after a few days of proximal urinary diversion [49]. If a stent can be placed an open repair is required only for persistent urinary leak or ureteric stricture formation [69,72].…”

“…Ureteric injuries with a significant delay in diagnosis are best managed initially by PCN drainage or endoscopic ureteric stenting [12,15,46,48]. Placing a PCN is usually safer and more universally applicable.…”

“…Of the selected external trauma articles, 34 class 3 and two class 4 articles focused on penetrating ureteric trauma, and four class 4 and six class 3 articles on blunt ureteric trauma. A further weakness is that nearly half of these external trauma articles included patients from the 1960s and 1970s, which pre-dates the common use of CT or JJ ureteric stenting [1,4,6,[9][10][11][14][15][16][17][18]21,22,[26][27][28] …”

“…Injuries that are detected after surgery or delayed tend to be more complex, require more complex repairs, require multiple procedures, and have higher rates of nephrectomy and death [7,13,15,34,41,45,74,117].…”

“…When the ureteric injury is missed and not diagnosed until late, or the primary repair fails, the complication rate increases considerably, including renal loss and even death [1, 11,13,15,16,18,[25][26][27][28][29][30][45][46][47][48]51,52]. Immediate diagnosis and proper management at the time of ureteric injury is essential to reduce potential morbidity and mortality.…”