Ureter trauma

Background

(1) Human urinary system: (2) kidney; (3) renal pelvis; (4) ureter; (5) urinary bladder (6) urethra.
Additional structures: (7) adrenal gland; (8) renal artery and vein; (9) inferior vena cava; (10) abdominal aorta; (11) common iliac artery and vein; (12) liver; (13) large intestine; (14) pelvis.

Renal anatomy.

Perinephric space with exaggerated pararenal space to show retroperitoneal structures. Perinephric bridging septa are seen between the left kidney and the adjacent renal fascia.

• 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

Genitourinary Trauma

• Urinary system
  • Renal trauma
  • Ureter trauma
  • Bladder trauma
  • Urethral trauma
    • Traumatic foley catheter removal
• Genital
  • Penile trauma
    • Traumatic foley catheter removal
  • Testicular trauma
  • Vaginal trauma
• Other
  • Child abuse
  • Pelvic fracture (often accompanies)
  • Sexual assault

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