Ureter trauma

Background

• 90% of non-iatrogenic injuries occur from penetrating injury
• Isolated ureter injury is rare

Clinical Features

• Symptoms usually nonspecific
• Hematuria present in ~70%
• Delayed signs of occult injury include:
  • Fever/sepsis, flank pain, ileus, urinary leakage or obstruction
• Complications include :
  • Peritoneal or retroperitoneal urinary leakage
  • Perinephric abscess
  • Fistula formation (e.g. ureterovaginal, uterocutaneous)
  • Ureteral stricture/obstruction

Differential Diagnosis

Abdominal Trauma

• Abdominal compartment syndrome
• Diaphragmatic trauma
• Duodenal hematoma
• Genitourinary trauma
• Liver trauma
• Pelvic fractures
  • Acetabular pelvic fractures
  • Open book pelvic fracture
  • Straddle pelvic fracture
  • Pelvic avulsion fracture
• Retroperitoneal hemorrhage
• Renal trauma
• Splenic trauma
• Trauma in pregnancy
• Ureter trauma

Evaluation

• Absence of hematuria does NOT rule out ureteral injury
• If CT is nondiagnostic but high index of suspicion perform IV urography or retrograde pyelography

Management

• Surgery

Disposition

• Admit

See Also

• Genitourinary trauma