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Ureteral injury

Key sources
The following summarized guidelines for the evaluation and management of ureteral injury are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2022), the World Society of Emergency Surgery (WSES/AAST 2019), and the American Urological Association (AUA 2014).
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Guidelines

1.Screening and diagnosis

Diagnosis: as per EAU 2022 guidelines, suspect ureteral injury in all cases of abdominal penetrating trauma, and in deceleration-type blunt trauma.
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2.Diagnostic investigations

Computed tomography: as per WSES 2019 guidelines, obtain IV contrast-enhanced CT with delayed phase in hemodynamically stable or stabilized patients with suspected ureteral injury.
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3.Therapeutic procedures

Ureteral stenting: as per EAU 2022 guidelines, perform nephrostomy tube/JJ stent urinary diversion for the management of iatrogenic ureteral injuries with delayed diagnosis.
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4.Surgical interventions

Indications for surgery
As per EAU 2022 guidelines:
Perform immediate repair of iatrogenic ureteral injuries detected during surgery.
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Perform ureteral reconstruction of ureteral strictures according to the location and length of the affected segment.
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5.Specific circumstances

Patients with ureterovaginal fistula: perform stenting in patients with ureterovaginal fistula, when possible. Consider performing additional surgical intervention if the stent fails.
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6.Preventative measures

Prevention of iatrogenic injury
Visually identify the ureters to prevent ureteral trauma during abdominal and pelvic surgery.
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Use preoperative prophylactic stents in high-risk cases.
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7.Follow-up and surveillance

Serial imaging assessment: obtain CT with delayed phase as the choice of follow-up imaging in patients with ureteral injuries.
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