Gunshot wounds to the ureter

Area of Science:

• Trauma Surgery
• Urology
• Ballistics Medicine

Background:

• Ureteral gunshot injuries are uncommon but can involve significant associated trauma.
• Previous reviews highlight the complexity and management challenges of these injuries.
• This study updates findings on 17 additional patients treated for ureteral gunshot wounds.

Purpose of the Study:

• To review recent cases of ureteral gunshot injuries and their management.
• To evaluate the efficacy of specific surgical repair techniques.
• To assess short- and long-term outcomes and complications.

Main Methods:

• Retrospective review of 17 patients treated for ureteral gunshot injuries.
• Analysis of injury location (upper, middle, lower ureter) and associated visceral injuries.
• Evaluation of surgical repair methods including resection, end-to-end anastomosis, stenting, and T-tube drainage.

Main Results:

• 17 patients treated; injuries involved upper (6), middle (2), and lower (9) ureter.
• Commonly associated injuries included small intestine and, in over 50% of lower ureter injuries, iliac vein.
• No hospital mortality; optimal repair resulted in excellent outcomes and no long-term complications.

Conclusions:

• Optimal surgical repair involving generous resection, primary end-to-end anastomosis, and stenting provides excellent results for ureteral gunshot injuries.
• This approach is effective even with severe associated injuries and careful follow-up.
• Established principles of repair are crucial for managing these rare but serious traumatic events.