When a ureteral injury is identified at the time of surgery in a patient who is haemodynamically unstable, definitive reconstruction is typically not the immediate priority. The clinical challenge is balancing ureteral repair against the patient's overall physiological status.
Ureteral injury recognised immediately (intraoperatively) in a haemodynamically unstable patient. In this setting, a damage control approach is preferred: the focus shifts away from primary repair and toward expedient urinary diversion, with definitive management deferred until the patient is stabilised.
The immediate management involves urinary diversion rather than primary reconstruction. Options include temporary or permanent diversion techniques — the full structured protocol details the specific interventions, decision criteria, and circumstances under which nephrectomy may become necessary.
In cases of unstable trauma patients, a 'damage control' approach is preferred with ligation of the ureter, diversion of the urine (e.g. via a nephrostomy), and a later delayed definitive repair.
Following early or late repairs, up to 38% of patients develop secondary ureteric strictures requiring interventions or palliative management by indwelling ureteric catheter or nephrostomy tube.
Moreover, in some series up to 10% of failed repairs have evidence of renal parenchyma or function loss, leading to nephrectomy.
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