[Injuries of the ureter caused by external force]

Based on 10 own cases during the past 12 years, and a review of the literature, the subject is divided into classification and correlations, morbidity, aetiology, traumatogenesis and pathomechanisms, pathological anatomy and physiology, diagnostical pathways, therapy and results. There are closed and open injuries of the ureter, isolated and combined ones, and among the latter, combined related and not related. This injury is rare in general; in overseas countries, more often the open and in Central Europe, mostly the closed trauma can be seen. The indirect rupture of the ureter happens by hyperlordosis, the direct rupture by wheel lesion. The prevalence of youth for the indirect mechanism of the injury is explained by the hyperextensibility of the lumbar region in juveniles. Usually, the rupture is located proximally, a distal rupture (pelvic fracture) is an exception. Criteria of the closed injury are urinoma within Gerota's fascia and local resorption, later infection or urosepsis. The open injury is marked additionally by abdominal resorption of urine, followed by uremia and peritonitis. Delayed diagnosis is common, as the trauma causes few symptoms initially. Further, it is often obscured by concomitant injuries. For therapy, the rupture must be closed operatively by suture and splint. The operative approach follows usually the lumbar, but in cases of concomitant abdominal injury the abdominal route. Loss of kidney occurs in 20% and lethal outcome in 10%.