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.