A review of ureteral injuries after external trauma.
BACKGROUND
Ureteral 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.


METHODS
Eighty-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%.


CONCLUSIONS
The 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.
DeWitt Daughtry Family Department of Surgery, Leonard M, Miller School of Medicine, University of Miami/Jackson Memorial Hospital, Ryder Trauma Center, Miami, FL, USA. bpereira@med.miami.edu
Bruno M T
BM
Pereira
Michael P
MP
Ogilvie
Juan Carlos
JC
Gomez-Rodriguez
Mark L
ML
Ryan
Diego
D
Peña
Antonio C
AC
Marttos
Louis R
LR
Pizano
Mark G
MG
McKenney
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D014513:Ureter / Q000293:injuries* / Q000601:surgery; D013519:Urogenital Surgical Procedures / Q000009:adverse effects / Q000379:methods; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000601:surgery