Traumatic ureteral injuries: a single institution experience validating the American Association for the Surgery of Trauma-Organ Injury Scale grading scale.
OBJECTIVE
Ureteral injuries are uncommon and challenging. In this study we report our institutional experience with ureteral injuries. We evaluated the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) for ureteral injuries as a predictor of outcomes for complexity of repair, morbidity, mortality and associated injuries.


METHODS
We performed a retrospective, 120-month study (January 1992 to December 2002) at an urban, level I trauma center.


RESULTS
In the 57 patients mean hospital Admission blood pressure +/- SD was 115 +/- 25 mm Hg, mean Revised Trauma Score was 7.38 +/- 0.84 and mean Injury Severity Score was 15 +/- 1.15. The mechanism of injury was penetrating in 55 cases (96.5%), including gunshot wound in 52 (54.5%) and stab wound in 2 (5.5%), and in blunt 2 of motor vehicle accidents (3.5%). The anatomical location was the left side in 33 cases (58%), right side in 23 (40%) and bilateral in 1 (2%). The distribution of injuries was proximal in 15 cases (26%), mid in 21 (37%) and distal in 21 (37%). Associated injuries were present in 56 patients (98%). An intraoperative diagnosis was made in 44 cases (77%). Of the patients 50 (88%) required complex repairs or an adjunct procedure, including a double pigtail stent in 33 (58%), ureteroureterostomy in 20 (35%), ureteroneocystostomy with a psoas hitch in 10 (18%), external diversion in 9 (16%), suprapubic cystostomy in 8 (14%), nephrostomy in 2 (3.5%), nephrectomy in 2 (3.5%) and ligation in 2 (3.5%). Injury grade was I to V in 5 (8%), 8 (13%), 13 (22.8%), 18 (31.6%) and 13 (22.8%) cases, respectively. Overall 51 patients (89%) survived. No deaths were related to ureteral injury. Renal salvage was achieved in 49 of the 51 surviving patients (96%).


CONCLUSIONS
Ureteral injuries are uncommon. The complexity of repair and number of associated injuries increase with AAST-OIS injury grade. Mortality increases with AAST-OIS injury grade but it is not related to the ureteral injury. Excellent results can be achieved with complex techniques of primary repair, leading to renal salvage.
Best
Charles D
CD
Department of Urology and Division of Trauma and Critical Care, Los Angeles County and University of Southern California, Los Angeles, California 90089, USA. cbest@usc.edu
Petrone
Patrizio
P
Buscarini
Maurizio
M
Demiray
Sinan
S
Kuncir
Eric
E
Kimbrell
Brian
B
Asensio
Juan A
JA
D000328:Adult; D002965:Classification; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015601:Injury Severity Score; D007430:Intraoperative Care; D007668:Kidney / Q000293:injuries / Q000601:surgery; D008297:Male; D009104:Multiple Trauma; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D014504:Urban Health; D014513:Ureter / Q000293:injuries* / Q000601:surgery; D001743:Urinary Bladder / Q000293:injuries / Q000601:surgery; D014547:Urinary Diversion / Q000379:methods; D014948:Wounds, Gunshot / Q000145:classification / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000601:surgery; D014951:Wounds, Stab / Q000145:classification / Q000601:surgery