Penetrating injuries of the ureter

Eighteen cases of penetrating ureteral injury encountered over 10 years are reviewed. Low-velocity gunshot was the mode of injury in 16. All levels of the ureter were represented with near-equal incidence. Stented uretero-ureterostomy was the primary mode of management, offering satisfactory results, with temporary urine leaks resolving spontaneously in four, responding to temporary catheter diversion in one, and requiring reoperation in two. Plastic stenting was inferior to silastic or rubber materials. Colon and/or bowel injury was universal and was not found to justify alteration in choice of surgical timing or technique, or to influence overall results. Adequately drained urine poses no threat to cicatricial stenosis. Urography is reliable; retrograde studies are dependable when urography is equivocal.