Gunshot wounds to the ureter.

Since our last review 17 more patients have been treated for ureteral gunshot injuries. In six cases the upper ureter, in two the middle, and in nine cases the lower ureter was involved. Associated visceral injuries were numerous with the small intestine the most commonly injured. In over 50% of the injuries to the lower ureter, the iliac vein was injured. In three patients the ureter was the only major structure involved. There was no hospital mortality. Optimal surgical repair done by generous resection, primary end-to-end anastomosis and stenting and drainage via a proximal ureteral T-tube gave excellent results and no longterm complications in a population subject to careful short and longterm followup. While an uncommon injury, the principles of effective repair are clear and must be applied in the face of serious associated disorders to continue these satisfactory results.