Evaluation and Management of Non-iatrogenic Ureteral Trauma

Purpose of Review: Ureteral injuries are rare and represent a minority of genitourinary injuries in trauma patients. Their association with complex polytrauma and propensity for delayed recognition present diagnostic and therapeutic challenges. Herein, we present a review of the available literature on the evaluation and management of non-iatrogenic ureteral injuries. Recent Findings: The incidence of traumatic ureteral injury appears to be increasing as a result of improved trauma survivability and enhanced imaging techniques. While most of the ureteral trauma literature reports on penetrating mechanisms of injury, blunt ureteral injuries are typically associated with more severe injury scores. Diagnosing traumatic ureteral injuries continues to be challenging and clinical suspicion should guide subsequent evaluation based on the patient’s condition. Computerized tomography with intravenous contrast and excretory phase imaging is the gold standard for evaluating suspected ureteral injuries in clinically stable trauma patients. Many ureteral injuries will still be diagnosed intraoperatively and may be successfully temporized or definitively reconstructed acutely. In unstable patients, damage control principles have been adapted to ureteral trauma permitting delayed reconstruction. Delayed diagnosis of these injuries has been associated with increased morbidity, mortality, length of stay, and renal loss. Summary: Traumatic ureteral injuries are rare and require a high index of suspicion. Patient physiology may guide the evaluation and eventual treatment of these injuries. Improved detection, management, and vigilance for potential complications of traumatic ureteral injuries can improve patient outcomes and decreased resource utilization.