During the course of an operation on an unstable, critically ill patient, the left ureter is lacerated through 50% of its circumference. If the patients condition is felt to be too serious to allow time for definitive repair, alternative methods of management include:
|A||Ligation of the injured ureter and ipsilateral nephrostomy|
|C||Placement of a catheter from the distal ureter through an abdominal wall stab wound|
|D||Placement of a suction drain adjacent to the injury without further manipulation that might convert the partial laceration into a complete disruption|
a. In cases of ureteral injury after external violence, it is sometimes necessary to treat the injured ureter by deferring definitive treatment until later.
c. There are four options for damage control in ureteral injuries:
i. Do nothing, but plan a reoperation when the patient is more stable, usually within 24 hours;
ii. Place a ureteral stent and do nothing else;
iii. Exteriorize the ureter; or
iv. Tie off the ureter and plan percutaneous nephrostomy ).
d. In most cases of planned staged repair, we tie off the damaged ureter, using long silk ties to aid the dissection of the ureteral stump during the second-stage repair.
e. The kidney is then drained percutaneously. We advocate percutaneous placement of a nephrostomy tube, either by the surgeon just postoperatively or later by interventional radiology specialists.