Ureteral Gunshot Wounds

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

“…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] …”

“…Once the injured ureter is exposed, the general principles for ureteric reconstruction include: (i) careful ureteric mobilization (with care to preserve the adventitia); (ii) debridement of devitalized tissue, until there is a bleeding edge [11]; (iii) mucosa to mucosa, spatulated,…”

“…Most reported repairs with UU are with the abdominal ureter (above the iliac artery bifurcation Lacerations involving the middle or upper third of the ureter are often best managed by primary UU [4,9,11,12,14,46,47]. After debriding nonviable ureter, each end is spatulated on opposite sides and a watertight, tension-free anastomosis made, over a ureteric stent, using absorbable sutures.…”

“…Strictures develop when an ischaemic ureter, often from extensive adventitial dissection, radiation or blast injury, heals by scar tissue [11,13,16,22,31,40,46,49,110]. Flank or abdominal pain and UTI/pyelonephritis is a common presentation.…”

“…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.…”