During the course of an operation on an unstable, critically ill patient, the left ureter is lacerated through 50% of its circumference. If the patient's condition is felt to be too serious to allow time for definitive repair, alternative methods of management include

If time and the patient's condition permit, primary ureteral reconstruction should be carried out. In the middle third of the ureter, this will usually consist of ureteroureterostomy using absorbable sutures over a stent. If the injury involves the upper third, ureter pyeloplasty may be necessary. In the lower third, ureteral implantation into the bladder using a tunneling technique is preferred. If time does not permit definitive repair, suction drainage adjacent to the injured segment alone is inadequate; either ligation and nephrostomy or placement of a catheter into the proximal ureter is an acceptable alternative that would allow reconstruction to be performed later. The creation of a watertight seal is difficult and nephrectomy may be required if the injury occurs during a procedure in which a vascular prosthesis is being implanted (e.g., an aortic reconstructive procedure) and contamination of the foreign body by urine must be avoided.