Bilateral pelvi-ureteric avulsion following closed trauma

A 9-year-old girl suffered severe multiple injuries in a road traffic accident. Following a period of anuria an intravenous pyelogram was performed indicating bilateral pelvi-ureteric rupture. Continuity was eventually achieved on both sides following two attempts at ureteral anastomosis. One year after the accident the child is well and the kidneys and ureters are functionally normal. Early diagnosis and treatment is essential in order to achieve a good functional result. This is aided by an awareness of the condition and is confirmed by intravenous and retrograde pyelography. The anastomosis is performed over a polythene splint, supported by a defunctioning nephrostomy for several weeks. The aetiology remains obscure, although there have been many suggestions regarding the mechanics of pelvi-ureteric avulsion.