You are here: Urology Textbook > Ureters > Ureter injury

Diagnosis and Treatment of Ureteral Injury and Ureter Trauma

Definition of Ureteral Injury

Ureteral injury is rare and usually caused by penetrating trauma (gunshot or stab wounds). Another mechanism of injury is ureteral tearing due to deceleration trauma (Elliott and McAninch, 2003) (Elliott and McAninch, 2006). EAU Guidelines: Urological Trauma.

**Left-sided ureteral injury:** abdominal CT (excretion phase) and retrograde pyelography after fall from great height. Additional injury were a ruptured spleen and grade IV kidney injury. With kind permission (left figure), Prof. Dr. K. Bohndorf, Augsburg.

Classification of Ureteral Injury

Classification of ureteral injuries according to AAST, advance one grade for bilateral injuries:

Grade I: hematoma without devascularization
Grade II: laceration with under 50% transection
Grade III: laceration with over 50% transection
Grade IV: laceration with complete transection and less than 2 cm devascularization
Grade V: laceration or avulsion with more than 2 cm devascularization

Signs and Symptoms of Ureter Injury

The mechanism of injury usually dominates the symptoms of ureteral injury. Additional signs of ureter trauma are abdominal pain, fever, upper urinary tract obstruction, urinoma, hematuria, peritonitis, or urine secretion via the wound.

Diagnostic Workup in Suspected Ureteral Injury

Abdominal and renal sonography
Intravenous urography, or better an abdominal computed tomography
Cystoscopy, retrograde pyelography, and ureteroscopy, if endoscopic treatment is deemed possible

Treatment of Ureteral Injury

Minor ureteral injuries can be managed with endoscopic treatment (Insertion of a ureteral stent, percutaneous nephrostomy). Surgical treatment is necessary for significant ureteral injury (suture repair, ureteroureterostomy, ureteral reimplantation with psoas hitch or Boari flap, transureteroureterostomy or ureteral reimplantation) or long-segment ureteral stricture.

Extrarenal calyces

Index

Iatrogenic injury

Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

References

EAU Guidelines: Urological Trauma

Elliott und McAninch 2003 ELLIOTT, S. P. ; MCANINCH, J. W.: Ureteral injuries from external violence: the 25-year experience at San Francisco General Hospital.
In: J Urol
170 (2003), Nr. 4 Pt 1, S. 1213–6

Elliott, S. P. & McAninch, J. W. Ureteral injuries: external and iatrogenic
Urol Clin North Am, 2006, 33, 55-66, vi

Preston 2000 PRESTON, J. M.: Iatrogenic ureteric injury: common medicolegal pitfalls.
In: BJU Int
86 (2000), Nr. 3, S. 313–7

Deutsche Version: Traumatische und iatrogene Verletzung des Harnleiters