The use of indwelling ureteral stents in managing ureteral injuries due to external violence.
Eighteen consecutive cases of ureteral injury due to external violence occurring over a 6-year period were reviewed. The diagnosis of ureteral injury was made either preoperatively on an intravenous urogram, or intraoperatively using indigo carmine. No patient had an isolated ureteral injury. Four patients with ureteral contusions were managed expectantly and needed no further therapy. Eleven patients with ureteral lacerations underwent spatulated, interrupted anastomoses of absorbable suture and placement of Silastic double-J ureteral catheters and had prompt resolution of urinary drainage and normal urograms post stent removal. Two initially nonstented patients with lacerations required delayed ureteral stent placement for massive retroperitoneal urine leakage while one patient did well with simple ureteroureterostomy without stenting. The only important complication from the use of ureteral stents was limited to a single patient, who failed to return for followup and developed a staghorn calculus on the stent. The use of Silastic double-J ureteral catheters resulted in little morbidity and allowed: relatively maintenance-free care; an extra measure of safety in multiply injured patients; and early hospital discharge.