injuries poisoning
Ureteral Trauma
Treatment of Ureteral Trauma
For minor injuries, percutaneous nephrostomy tube or ureteral stent For major injuries, surgical repair All ureteral injuries require intervention. A diverting percutaneous nephrostomy tube and/or placement of a ureteral stent (retrograde or antegrade) is often sufficient for minor injuries (eg, contusions or partial transections). Minor iatrogenic intraoperative ureteral injuries such as a partial laceration can be managed with primary closure. In the case of unintended ligation with a suture, suture removal may be adequate. All repairs should be stented. Major injuries (eg, complete transection or avulsion injuries) typically require reconstructive techniques, either open or laparoscopic, depending on their location and extent. These techniques include ureteral reimplantation, primary ureteral anastomosis, anterior (Boari) bladder flap, transureteroureterostomy, ileal interposition, and as a last resort, autotransplantation. In unstable patients a damage control approach is used whereby the ureter is temporarily drained with definitive management deferred. 