Ureteral injury

The management of ureteral injuries resulting from external violence or surgery is usually straightforward and is primarily a problem of recognition and development of a treatment plan that allows either repair of the injury away from the site of pathology or conservative drainage and diversion. However, decisions as to the proper therapy can be complicated by legal, economic, and emotional considerations, which make management of these patients difficult. In the last 5 years, endoscopic manipulation of the ureter for the treatment of stones and stricture has become commonplace. Perforation of the ureter occurs in as many as 20 per cent of cases. Sequelae from these inadvertent injuries are rare, particularly if the injury is managed by proximal diversion with percutaneous nephrostomy and placement of a ureteral stent. Three to ten days of drainage is usually all that is required to heal these injuries. The ureter, of course, may also be avulsed during the course of basket extraction of stone, and open operative correction would then be required. The ureter is a delicate structure. To paraphrase a famous patriot, force in the cause of ureteral stone extraction or ureteral catheterization is a vice!