ISSN: 1305-3876
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Ureter Traumas
Dr. Mesut ÇETİNKAYA,a Dr. Özgür UĞURLUa
a2. Üroloji Kliniği, Ankara Numune Eğitim ve Araştırma Hastanesi, ANKARA
Because of its well protected location anatomically and its deep course, trauma to the ureter is relatively rare. Approximately one percent of all the urogenital system traumas are ureter traumas. Approximately eighty percent of ureter traumas are iatrogenic. The cause of iatrogenic ureter traumas in 70% of the cases are gynecologic operations, followed by urological and general surgical procedures respectively. Most external ureteric injuries occur from gunshot wounds and blunt traumas. It is possible to perform a successful repair if ureter traumas are recognized acutely; however, delay in diagnosis causes increase in morbidity. Many ureter traumas could not recognized at the time of injury. Surgical principles for successful repair of ureter traumas are adequate ureteric debridement, selecting the appropriate method, and a careful anastomosis.
Different classifications of ureter traumas according to type, localization, and size of the trauma are possible. However, more than one classification is used at once in practice when defining ureter traumas.
Although hematuria, flank pain, echymosis in flank region, and development of a mass are the main symptoms, they are not patognomonic. Retrograde pyelograms, intravenous pyelograms, and CT are the basic examinations. Findings suggestive of ureteral injury include extravasation of contrast from the traumatic ureter region, non-functioning kidney, ureteric deviation and nonvisualization of the some regions of ureter.
Prompt recognition and early treatment of ureter trauma often result in a successful outcome in the greater majority of the patients. Ureteric catheterization can be adequate when the trauma is recognized in minor traumas. Minor traumas that are not recognized acutely are often complicated by ureteric strictures in the postoperative period. However, major external traumas and loss of a longer segment in iatrogenic traumas require more complicated surgical methods. Primary repair is the first choice in partial transections, if possible. The method of first choice in any traumatic ureter region is uretero-ureteral anastomosis following an adequate debridement and spatulation. Ureteroneocystostomy, Boari-flap technique, transureteroureterostomy, psoas hitch method, ileal substitution, and autotransplantation are other techniques.Keywords: Ureter; injuryTurkiye Klinikleri J Surg Med Sci 2007, 3(21):14-24
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