War injuries of the ureter

Area of Science:

• Urology
• Trauma Surgery
• Military Medicine

Background:

• The Croatian War of Independence (1991-1992) resulted in a significant number of casualties requiring medical treatment.
• Urogenital injuries represent a subset of trauma sustained during armed conflict.
• Specific data on the incidence and management of ureteral injuries in wartime are limited.

Purpose of the Study:

• To report the incidence of ureteral injuries among wounded patients during the 1991-1992 war in Croatia.
• To describe the diagnostic methods and surgical interventions employed for ureteral injuries.
• To analyze the outcomes of different management strategies for ureteral trauma in a wartime setting.

Main Methods:

• Retrospective analysis of 4,425 wounded patients treated at Clinical Hospital Osijek between 1991 and 1992.
• Identification of patients with urogenital and specifically ureteral injuries.
• Review of surgical procedures performed (ureteroureteral anastomosis, ureterocystoneostomy, exploration, nephrectomy) and patient outcomes.

Main Results:

• 115 patients (2.6%) sustained urogenital injuries, with 11 (9.5% of urogenital injuries) having ureteral injuries.
• Ureteral injuries were often discovered incidentally during abdominal surgery for other trauma.
• Non-operative management of ureteral contusions resulted in ureteral stenosis (3 cases) and complete ureteral lumen obliteration (1 case).

Conclusions:

• Ureteral injuries are uncommon but serious consequences of war trauma.
• Incidental discovery during exploratory surgery is a common presentation.
• Failure to surgically reconstruct ureteral injuries can lead to significant long-term complications like stenosis and obliteration.