A review of ureteral injuries after external trauma

Bruno M.T. Pereira, Michael P. Ogilvie, Juan C. Gomez-Rodriguez, Mark L. Ryan, Diego Peña, Antonio C. Marttos, Louis R. Pizano, Mark G. McKenney

Research output: Contribution to journalReview article

40 Citations (Scopus)

Abstract

Introduction: 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.Literature review: 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%.Conclusion: 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.

Original languageEnglish (US)
Article number6
JournalScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Volume18
Issue number1
DOIs
StatePublished - Feb 3 2010
Externally publishedYes

Fingerprint

Wounds and Injuries
Ureter
Stents
Urinalysis
Mortality
Urography
Hematuria
Operating Rooms
Morbidity
Population

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Pereira, B. M. T., Ogilvie, M. P., Gomez-Rodriguez, J. C., Ryan, M. L., Peña, D., Marttos, A. C., ... McKenney, M. G. (2010). A review of ureteral injuries after external trauma. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 18(1), [6]. https://doi.org/10.1186/1757-7241-18-6

A review of ureteral injuries after external trauma. / Pereira, Bruno M.T.; Ogilvie, Michael P.; Gomez-Rodriguez, Juan C.; Ryan, Mark L.; Peña, Diego; Marttos, Antonio C.; Pizano, Louis R.; McKenney, Mark G.

In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol. 18, No. 1, 6, 03.02.2010.

Research output: Contribution to journalReview article

Pereira, BMT, Ogilvie, MP, Gomez-Rodriguez, JC, Ryan, ML, Peña, D, Marttos, AC, Pizano, LR & McKenney, MG 2010, 'A review of ureteral injuries after external trauma', Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 18, no. 1, 6. https://doi.org/10.1186/1757-7241-18-6
Pereira, Bruno M.T. ; Ogilvie, Michael P. ; Gomez-Rodriguez, Juan C. ; Ryan, Mark L. ; Peña, Diego ; Marttos, Antonio C. ; Pizano, Louis R. ; McKenney, Mark G. / A review of ureteral injuries after external trauma. In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2010 ; Vol. 18, No. 1.
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abstract = "Introduction: 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.Literature review: 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{\%}.Conclusion: 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.",
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N2 - Introduction: 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.Literature review: 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%.Conclusion: 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.

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