Ces Urol 2011, 15(3):158-166 | DOI: 10.48095/cccu2011029

Early surgical management of ureteral trauma

Jana Hlaváčová¹, Jan Jambura¹, Jiří Kouba¹, Jan Bulka², Viktor Eret¹, Milan Hora¹

¹ Urologická klinika LF UK a FN, Plzeň

² Radiodiagnostické oddělení FN, Plzeň

Aim:
We summarized our own experience and results of early surgical management of ureteral trauma (UT).

Methods:
In the period between January 1995 and January 2010 we treated 71 patients (15 men and 56 women) for UT. We evaluated our cohort in regard of advantage of indication of early surgical management. This is a retrospective study.

Results:
The mean age was 47 years (range 33-66). The most common cause of UT were gynaecological procedures (43%), less often endoscopical procedures (28%), colorectal operations (18%), ureter deliberations (5%), surgery of abdominal aortic aneurysm (3%), suprapubic prostatectomy (1.5%) and penetrating bullet trauma (1.5%). The UT was diagnosed by urine leakage into the operative wound in 18 cases, into the retroperitoneum in 16 cases, into the abdominal cavity 6 times and into the vagina 9 times. An obstruction causing the megaureter above was found in 19 cases, 2 times non-functioning kidney and once an anuria caused by bilateral ligature of ureters. As a surgical management of UT, there was indicated ureterocystostomy in 21 cases (15x early and 6x delayed), Boari bladder flap technique 6x (5x early and once delayed), 14x suture of the ureter (always peroperatively), 4x ureterorhaphy (3x early and once delayed), lx substitution of ureter loop of small intestine(early) 2x nephrectomy (delayed), lOx nephrostomy (9x early and once delayed), 13x retrograde ureteral stent placement (1 lx early and 2x delayed).

Conclusion:
Regardless of the chosen method of treatment in our group it was possible to address the UT early (within one week after the correct diagnosis) in 58 patients (81.7%). This early access to definitive treatment of the UT we proved. The patient benefits in particular shortening of the treatment. The ultimate determination of advantage of early surgical treatment of UT, would have required a prospective randomized study.

Keywords: Boari bladder flap, intravenous pyelography, nephrectomy, ureteral trauma, retrograde ureteral stent placement, ureteroneocystostomy

Received: August 23, 2010; Accepted: June 24, 2011; Published: June 1, 2011