Traumatic ureteral injury: an initial outcome and experience

Abstract

Traumatic ureteral injury is a rare and challenging condition of the urinary system. To summarize the clinical features of patients with traumatic ureteral injury and examine the literature on traumatic ureteral injuries from the past 20 years. The clinical data of 30 patients with traumatic ureteral injury in Peking University First Hospital, Beijing Jiangong Hospital, as well as Emergency General Hospital from August 2015 to August 2023 were retrospectively collected. The clinical characteristics, management strategies, and follow-up outcomes were analyzed, and a review of the literature on traumatic ureteral injury from the past 20 years was conducted. The traumatic types in the case series was composed of sharp injury, impact injury, and falling injury, with 9, 16, and 5 cases, respectively. Ureteral injury was diagnosed immediately in 12 cases, while 18 cases had a delayed diagnosis. Besides, the median time from ureteral injury to operations was 8.5 months (IQR: 4–13 months) in the patients who received upper urinary tract repair surgery, including ureteral stenting in one case, ureteroureterostomy in four cases, pyeloplasty in two cases, lingual mucosal graft ureteroplasty in one case, ileal ureter replacement in five cases, and nephrectomy in one cases. The mean follow-up time is 39.1 ± 24.8 months. Concerning renal function, postoperative creatinine was substantially lower than preoperative one (78.6 ± 13.7 µmol/L vs 88.8 ± 17.0 µmol/L, p = 0.0009), and postoperative urea was significantly lower than preoperative one (4.6 ± 1.6 µmol/L vs 5.9 ± 1. 3 mmol/L, p = 0.0016). Traumatic ureteral injury is challenging to recognize due to its deep anatomical location, making timely diagnosis crucial. It is important to choose an appropriate reconstruction method based on severity, location, length to restore urinary tract continuity as early as possible.