Penetrating ureteral trauma
OBJECTIVE: The purpose of this series is to report our experience in managing ureteral trauma, focusing on the importance of early diagnosis, correct treatment, and the impact of associated injuries on the management and morbid-mortality. MATERIALS AND METHODS: From January 1994 to December 2002, 14...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Urologia
2007-04-01
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| Series: | International Brazilian Journal of Urology |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382007000200003 |
| _version_ | 1828867509011349504 |
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| author | Gustavo P. Fraga Gustavo M. Borges Mario Mantovani Ubirajara Ferreira Tiago L. Laurito Nelson R. Netto Jr |
| author_facet | Gustavo P. Fraga Gustavo M. Borges Mario Mantovani Ubirajara Ferreira Tiago L. Laurito Nelson R. Netto Jr |
| author_sort | Gustavo P. Fraga |
| collection | DOAJ |
| description | OBJECTIVE: The purpose of this series is to report our experience in managing ureteral trauma, focusing on the importance of early diagnosis, correct treatment, and the impact of associated injuries on the management and morbid-mortality. MATERIALS AND METHODS: From January 1994 to December 2002, 1487 laparotomies for abdominal trauma were performed and 20 patients with ureteral lesions were identified, all of them secondary to penetrating injury. Medical charts were analyzed as well as information about trauma mechanisms, diagnostic routine, treatment and outcome. RESULTS: All patients were men. Mean age was 27 years. The mechanisms of injury were gunshot wounds in 18 cases (90%) and stab wounds in two (10%). All penetrating abdominal injuries had primary indication of laparotomy, and neither excretory urography nor computed tomography were used in any case before surgery. The diagnosis of ureteric injury was made intra-operatively in 17 cases (85%). Two ureteral injuries (10%) were initially missed. All patients had associated injuries. The treatment was dictated by the location, extension and time necessary to identify the injury. The overall incidence of complications was 55%. The presence of shock on admission, delayed diagnosis, Abdominal Trauma Index > 25, Injury Severity Score > 25 and colon injuries were associated to a high complication rate, however, there was no statistically significant difference. There were no mortalities in this group. CONCLUSIONS: A high index of suspicion is required for diagnosis of ureteral injuries. A thorough exploration of all retroperitoneal hematoma after penetrating trauma should be an accurate method of diagnosis; even though it failed in 10% of our cases. |
| first_indexed | 2024-12-13T05:12:19Z |
| format | Article |
| id | doaj.art-db3a16869f5f462082ba013eca5bb1db |
| institution | Directory Open Access Journal |
| issn | 1677-5538 1677-6119 |
| language | English |
| last_indexed | 2024-12-13T05:12:19Z |
| publishDate | 2007-04-01 |
| publisher | Sociedade Brasileira de Urologia |
| record_format | Article |
| series | International Brazilian Journal of Urology |
| spelling | doaj.art-db3a16869f5f462082ba013eca5bb1db2022-12-21T23:58:30ZengSociedade Brasileira de UrologiaInternational Brazilian Journal of Urology1677-55381677-61192007-04-0133214215010.1590/S1677-55382007000200003Penetrating ureteral traumaGustavo P. FragaGustavo M. BorgesMario MantovaniUbirajara FerreiraTiago L. LauritoNelson R. Netto JrOBJECTIVE: The purpose of this series is to report our experience in managing ureteral trauma, focusing on the importance of early diagnosis, correct treatment, and the impact of associated injuries on the management and morbid-mortality. MATERIALS AND METHODS: From January 1994 to December 2002, 1487 laparotomies for abdominal trauma were performed and 20 patients with ureteral lesions were identified, all of them secondary to penetrating injury. Medical charts were analyzed as well as information about trauma mechanisms, diagnostic routine, treatment and outcome. RESULTS: All patients were men. Mean age was 27 years. The mechanisms of injury were gunshot wounds in 18 cases (90%) and stab wounds in two (10%). All penetrating abdominal injuries had primary indication of laparotomy, and neither excretory urography nor computed tomography were used in any case before surgery. The diagnosis of ureteric injury was made intra-operatively in 17 cases (85%). Two ureteral injuries (10%) were initially missed. All patients had associated injuries. The treatment was dictated by the location, extension and time necessary to identify the injury. The overall incidence of complications was 55%. The presence of shock on admission, delayed diagnosis, Abdominal Trauma Index > 25, Injury Severity Score > 25 and colon injuries were associated to a high complication rate, however, there was no statistically significant difference. There were no mortalities in this group. CONCLUSIONS: A high index of suspicion is required for diagnosis of ureteral injuries. A thorough exploration of all retroperitoneal hematoma after penetrating trauma should be an accurate method of diagnosis; even though it failed in 10% of our cases.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382007000200003ureterwounds and injuriesreconstructive surgical procedures |
| spellingShingle | Gustavo P. Fraga Gustavo M. Borges Mario Mantovani Ubirajara Ferreira Tiago L. Laurito Nelson R. Netto Jr Penetrating ureteral trauma International Brazilian Journal of Urology ureter wounds and injuries reconstructive surgical procedures |
| title | Penetrating ureteral trauma |
| title_full | Penetrating ureteral trauma |
| title_fullStr | Penetrating ureteral trauma |
| title_full_unstemmed | Penetrating ureteral trauma |
| title_short | Penetrating ureteral trauma |
| title_sort | penetrating ureteral trauma |
| topic | ureter wounds and injuries reconstructive surgical procedures |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382007000200003 |
| work_keys_str_mv | AT gustavopfraga penetratingureteraltrauma AT gustavomborges penetratingureteraltrauma AT mariomantovani penetratingureteraltrauma AT ubirajaraferreira penetratingureteraltrauma AT tiagollaurito penetratingureteraltrauma AT nelsonrnettojr penetratingureteraltrauma |