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Ureteric injuries: diagnosis, management, and outcome
A M Ghali1, E M El Malik, A I Ibrahim
1Asir Central Hospital, Abha, Saudi Arabia.
The Journal of Trauma
|February 5, 1999
Summary
Delayed diagnosis is a key factor affecting outcomes for ureteric injuries, most commonly caused by iatrogenic trauma. Early and accurate diagnosis requires advanced imaging like retrograde or anterograde pyelograms.
Area of Science:
- Urology
- Surgical Trauma
- Diagnostic Imaging
Background:
- Ureteric injuries, both iatrogenic and traumatic, require precise diagnosis and management.
- Understanding factors influencing outcomes is crucial for patient care.
Purpose of the Study:
- To define causes of ureteric injuries.
- To identify optimal diagnostic and management strategies.
- To determine factors affecting patient outcomes.
Main Methods:
- Retrospective analysis of 35 patients with 40 ureteric injuries (1991-1996).
- Review of diagnostic and management techniques.
- Assessment of renal function preservation as an outcome measure.
Main Results:
- Iatrogenic injuries (63% from gynecologic procedures) were more common than traumatic injuries (75% from motor vehicle crashes).
- Retrograde and anterograde pyelograms achieved 100% diagnostic success, unlike direct inspection or intravenous urogram (33%).
- Complications occurred in 25% of cases; nephrectomy in 8%. Adverse factors included pediatric age, upper ureter injury, delayed diagnosis, urinoma, and associated organ injury.
Conclusions:
- Iatrogenic trauma is the leading cause of ureteric injuries.
- Delayed diagnosis is the primary controllable factor impacting outcomes.
- Advanced imaging (retrograde/anterograde pyelogram) is essential for accurate diagnosis, while factors like young age and associated trauma complicate outcomes.