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Ureteral injuries from penetrating trauma
S B Brandes1, M J Chelsky, R F Buckman
1Department of Urology, Temple University Hospital, Philadelphia, Pennsylvania 19140.
The Journal of Trauma
|June 1, 1994
Summary
Diagnosing ureteral injuries from penetrating trauma is challenging, as standard preoperative tests like urinalysis and high-dose intravenous urograms (IVUs) are often unreliable. A high index of suspicion is crucial for timely detection and treatment.
Area of Science:
- Urology
- Trauma Surgery
- Diagnostic Imaging
Background:
- Penetrating ureteral injuries are often missed preoperatively.
- Standard diagnostic methods have limited reliability.
Purpose of the Study:
- To evaluate the diagnostic challenges and outcomes of ureteral injuries from penetrating trauma.
- To assess the effectiveness of current diagnostic modalities and surgical repair.
Main Methods:
- Retrospective review of 12 patients with ureteral injuries from stab or gunshot wounds.
- Evaluation of preoperative diagnostic methods including urinalysis and high-dose intravenous urograms (IVUs).
- Surgical exploration and repair outcomes were analyzed.
Main Results:
- None of the 12 ureteral injuries were diagnosed preoperatively.
- High-dose IVUs were nondiagnostic in 9 out of 9 patients.
- Hematuria was absent in 45% of patients.
- One injury was initially missed despite surgical exploration.
- Surgical repair was successful with good outcomes and minimal complications.
Conclusions:
- Current preoperative diagnostic methods are unreliable for penetrating ureteral injuries.
- A high index of suspicion is essential for timely diagnosis.
- Prompt surgical intervention leads to successful repair and favorable outcomes.