Penetrating ureteral trauma

Abstract

Objective: The purpose of this series is to report our experience in managing ureteral trauma, focusing on the importance of early diagnosis, correct treatment, and the impact of associated injuries on the management and morbid-mortality. Materials and Methods: From January 1994 to December 2002, 1487 laparotomies for abdominal trauma were performed and 20 patients with ureteral lesions were identified, all of them secondary to penetrating injury. Medical charts were analyzed as well as information about trauma mechanisms, diagnostic routine, treatment and outcome. Results: All patients were men. Mean age was 27 years. The mechanisms of injury were gunshot wounds in 18 cases (90%) and stab wounds in two (10%). All penetrating abdominal injuries had primary indication of laparotomy, and neither excretory urography nor computed tomography were used in any case before surgery. The diagnosis of ureteric injury was made intra-operatively in 17 cases (85%). Two ureteral injuries (10%) were initially missed. All patients had associated injuries. The treatment was dictated by the location, extension and time necessary to identify the injury. The overall incidence of complications was 55%. The presence of shock on admission, delayed diagnosis, Abdominal Trauma Index > 25, Injury Severity Score > 25 and colon injuries were associated to a high complication rate, however, there was no statistically significant difference. There were no mortalities in this group. Conclusions: A high index of suspicion is required for diagnosis of ureteral injuries. A thorough exploration of all retroperitoneal hematoma after penetrating trauma should be an accurate method of diagnosis; even though it failed in 10% of our cases.

Penetrating Bladder Trauma: A High Risk Factor for Associated Rectal Injury

“…Direct inspection remains the fastest and most reliable method for detecting ureteric injury [17, 18]. An extended exploration of the retroperitoneum is mandatory in all cases of penetrating injury to this region.…”

Ureteral injuries from gunshots and shells of explosive devices

“…[231011] Associated injuries to the gastrointestinal tract are commonly present, and may modify the management of ureteral injury at initial procedure.…”

“…[1‐3] Recently, the increased incidence of injuries of the ureter can be explained by an increase in armed violence, especially due to the explosive devices that inflict a large number of causalities. Visceral injuries are commonly associated with ureteral injury and are easily identified in most cases.…”

“…[2] Patients with hemodynamic instability and extensive blood loss are more susceptible for ureteral lesions not identified at surgical exploration. [3‐7]…”

A review of ureteral injuries after external trauma

“…The medical literature review table is organized by year of publication in descending order (2008 -1961). Authors, study design, objectives, incidence (demographics, type of injury, ureter injured portion), admission diagnostics (urine analysis, IVU, CT scan, RPG, intraoperative diagnosis), surgical technique and complications (early and late) were compiled [7-9,11,13,16,19-21,25,27-29,32-36,39,42,48,49,51-53,55-59,61,62,64,67,69,81-119]. …”