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CME

Ureteral Trauma - Emergency Management

General Information

General InformationGeneral Information

Background

  • External trauma causes 20% of ureteral injuries, the rest occurs intraoperatively1

Anatomy

  • The ureters are retroperitoneal structures1
  • Proximally protected by the psoas muscles and vertebral column, distally protected by the pelvis

Etiology

  • Most ureteral injuries occur in the operating room (80%)1, often from gynecologic surgery
  • Of those occurring outside of the operating room, 60% are due to penetrating trauma2
    • Gunshot wounds (GSWs) are the most common cause
  • Blunt trauma
    • significant deceleration forces are required (motor vehicle collisions [MVC] or a fall from height)
    • injury typically occurs where ureters are fixed at ureteropelvic or ureterovesicular junctions1

Epidemiology

  • Uncommon: 3/10,000 trauma hospitalizations2
    • Least common cause of genitourinary trauma is due to small size and location3
  • 84% of patients with ureteral trauma are male2
  • Ureteral injuries are identified in 3% of abdominal gunshot wounds (GSWs)4,5

References

References

General references used

  1. Elliott SP, McAninch JW. Ureteral injuries: external and iatrogenic. Urol Clin North Am. 2006 Feb;33(1):55-66
  2. Siram SM, Gerald SZ, Greene WR, et al. Ureteral trauma: patterns and mechanisms of injury of an uncommon condition. Am J Surg. 2010 Apr;199(4):566-70
  3. Bryk DJ, Zhao LC. Guideline of guidelines: a review of urological trauma guidelines. BJU Int. 2016 Feb;117(2):226-34full-text
  4. Elliott SP, McAninch JW. Ureteral injuries from external violence: the 25-year experience at San Francisco General Hospital. J Urol. 2003 Oct;170(4 Pt 1):1213-6
  5. McGeady JB, Breyer BN. Current epidemiology of genitourinary trauma. Urol Clin North Am. 2013 Aug;40(3):323-34full-text
  6. Jankowski JT, Spirnak JP. Current recommendations for imaging in the management of urologic traumas. Urol Clin North Am. 2006 Aug;33(3):365-76
  7. Engel O, Rink M, Fisch M. Management of iatrogenic ureteral injury and techniques for ureteral reconstruction. Curr Opin Urol. 2015 Jul;25(4):331-5
  8. Tezval H, Tezval M, von Klot C, et al. Urinary tract injuries in patients with multiple trauma. World J Urol. 2007 Apr;25(2):177-84

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How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T909736, Ureteral Trauma - Emergency Management; [updated 2018 Nov 30, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T909736. Registration and login required.

Published by EBSCO Information Services. Copyright © 2020, EBSCO Information Services. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission.

EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.

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