External ureteral trauma

Trauma is a frequent cause of death and disability. Penetrating ureteral trauma is the most common mechanism of injury across multiple single-institution case series and retrospective reviews. This chapter offers practical guidance to the best practices in diagnosis, treatment and management of patients with external ureteral trauma. Approximately 90% of traumatic ureteral injuries occur in the setting of polytrauma. Associated injuries are not surprising given the ureter's anatomical proximity to intraabdominal, retroperitoneal, vascular, and skeletal structures. Advanced Trauma and Life Support (ATLS) guidelines dictate initial evaluation and treatment of all trauma patients and genitourinary injuries must be managed without violating ATLS and damage control surgical principles. With improved detection, management, and vigilance for potential complications of traumatic ureteral injuries, the morbidity, cost, and potential mortality of these injuries can be decreased and lead to improved patient outcomes.