Injuries of the Ureter

Weinberg, Sidney R.; Rosenberg, Joel W.

doi:10.1007/978-1-4612-5907-7_21

Cited by 6 publications

(3 citation statements)

References 36 publications

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“…The Boari flap does not always provide a sufficiently large flap and it replaces the damaged ureter with a tubularised flap that can be aperistaltic (Weinberg and Rosemberg, 1981). Damel's flap requires a large and difficult dissection of the posterior bladder wall and is often complicated by stenosis of the flap base.…”

Section: Discussionmentioning

confidence: 99%

Bladder Z‐plasty for the Repair of Ureteric Injuries Experimental Study in Sheep

Cormio¹,

Crovace²,

Lacalandra³

et al. 1993

British Journal of Urology

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There is general acceptance that the best substitute for a damaged distal ureter is an elongated bladder and that the bladder psoas hitch is the most reliable procedure. Nevertheless, it is not always sufficient to bridge a long ureteric gap. In order to obtain an equally safe but wider bladder elongation than the psoas hitch can provide, we have previously studied the effect of several Z-shaped incisions on isolated pig bladders. The aim of the present study was to verify, in vivo, the efficacy and safety of the new technique. Five sheep underwent the psoas hitch procedure and 6 the Z-plasty procedure. The results showed that Z-plasty provides an equally safe but longer bladder elongation than the psoas hitch procedure.

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Section: Discussionmentioning

confidence: 99%

Bladder Z‐plasty for the Repair of Ureteric Injuries Experimental Study in Sheep

Cormio¹,

Crovace²,

Lacalandra³

et al. 1993

British Journal of Urology

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“…Some authors oppose the use of indwelling stents in the setting of ureteral trauma, citing such potential problems as obstruction, stricture formation, inflammation from the foreign body, stent migration and patient discomfort, however, this is not supported by the current surgical literature [ 36 , 47 ]. Other authors have argued that the benefits of the ureteral stent in the management of this injury far outweigh the potential risks and advocate use of a stent, especially in the setting of high-velocity gunshot wounds [ 12 , 37 , 38 , 41 , 48 - 51 ].…”

Section: Diagnosis and Managementmentioning

confidence: 99%

A review of ureteral injuries after external trauma

Pereira

Ogilvie

Gómez-Rodríguez

et al. 2010

Scand J Trauma Resusc Emerg Med

109

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IntroductionUreteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this article is to review the literature since 1961 with the primary objective to present the largest medical literature review, to date, regarding ureteral trauma. Several anatomic and physiologic considerations are paramount regarding ureteral injuries management.Literature reviewEighty-one articles pertaining to traumatic ureteral injuries were reviewed. Data from these studies were compiled and analyzed. The majority of the study population was young males. The proximal ureter was the most frequently injured portion. Associated injuries were present in 90.4% of patients. Admission urinalysis demonstrated hematuria in only 44.4% patients. Intravenous ureterogram (IVU) failed to diagnose ureteral injuries either upon admission or in the operating room in 42.8% of cases. Ureteroureterostomy, with or without indwelling stent, was the surgical procedure of choice for both trauma surgeons and urologists (59%). Complications occurred in 36.2% of cases. The mortality rate was 17%.ConclusionThe mechanism for ureteral injuries in adults is more commonly penetrating than blunt. The upper third of the ureter is more often injured than the middle and lower thirds. Associated injuries are frequently present. CT scan and retrograde pyelography accurately identify ureteral injuries when performed together. Ureteroureterostomy, with or without indwelling stent, is the surgical procedure of choice of both trauma surgeons and urologists alike. Delay in diagnosis is correlated with a poor prognosis.

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“…Development of ureteric fistula has been related to the extent of periureteric dissection, the stage of disease, the experience of the surgeon and surgical techniques able to prevent ureteric complications (4±7) . The majority of fistulas are the consequence of ischemia due to extensive ureteric devascularization which cannot be recognized intra-operatively (8,9) , therefore its prevention is based on the careful preservation of ureteric blood supply. This is generally obtained by preserving periureteric sheath and mesoureter and limiting the extent of ureteric dissection (3,10,11) .…”

mentioning

confidence: 99%

Ureteric complications following type 3-4 radical hysterectomy in patients with locally advanced cervical cancer

Benedetti‐Panici

Maneschi

Cutillo

et al. 1997

Int J Gynecol Cancer

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In order to assess the incidence, and factors influencing the risk of ureteric complications in patients with stage IB‐IIA>4 cm, IIB, II, III cervical cancer who underwent type 3–4 radical hysterectomy following neoadjuvant chemotherapy, data from 157 consecutive patients were analyzed. Among these, 90 patients entered a randomized study aimed to assess the efficacy of a ureteric stent in preventing ureteric complications. In these patients one ureter, randomly chosen, was stented before surgery, the surgeon being unaware of which. Ureteric dissection consisted in the isolation of the ureter from the superficial and deep layer of the vesico‐uterine ligament and cutting of the ligament 1 cm from (type 3) or at bladder insertion (type 4). To prevent the distal ureter from being immersed in pelvic dead space, a protecting wall approximating the stumps of the anterior and posterior parametria was performed. Ureteric fistula was observed in 11 (7%) patients of the whole series of 157 patients and stricture in three (2%) patients. The incidence of fistula declined from 13% of the first 31 patients to 0% of the last 36 patients. Chi‐square analysis showed that ureteric stenting, cumulative surgical experience expressed as date of surgery, age and the construction of the protecting wall significantly affected the risk for fistula formation (P<0.05). Mild ureteric dilatation was observed in 53% of ureters not stented. Spontaneous resolution was observed in all patients at 6–12 months. Fistula was the most striking ureteric complication following type 3–4 radical hysterectomy. Increased skill of the operating team may explain the reduced frequency of ureteric damage over time, since this made it possible to actually respect the periureteric plexus which is the only vessel to the distal ureter after cutting the ureteric blood supply from the hypogastric artery. Although the ability of a ureteric stent to prevent fistula formation was shown, stent‐induced morbidity and the importance of surgical skill in preventing ureteric damage suggest that routine stent utilization be avoided.

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Injuries of the Ureter

Cited by 6 publications

References 36 publications

Bladder Z‐plasty for the Repair of Ureteric Injuries Experimental Study in Sheep

Bladder Z‐plasty for the Repair of Ureteric Injuries Experimental Study in Sheep

A review of ureteral injuries after external trauma

Ureteric complications following type 3-4 radical hysterectomy in patients with locally advanced cervical cancer

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