Section 11. Kidney and Urinary Tract Disorders

Chapter 150. Injury to the Urinary Tract

Topics: Introduction | Kidney Injuries | Ureteral Injuries | Bladder Injuries | Urethral Injuries

Ureteral Injuries

Most injuries to the ureter occur during pelvic or abdominal operations, such as removal of the uterus (hysterectomy) or the colon, or during ureteroscopy (an examination of the ureter with a flexible viewing tube). Another cause of ureteral injury is penetration by either a gunshot or stab wound. A ureteral injury from a direct blow to the body is uncommon. Rarely, blunt injuries, particularly those that cause the trunk to bend backward, can separate the upper part of the ureter from the kidney.

Symptoms and Diagnosis

If ureteral injuries are untreated, complications, such as formation of a fistula (abnormal connection to another abdominal structure), stricture (narrowing of the ureter), or persistent urinary leakage and infection, may result.

Often, an injury to the ureters may not be recognized promptly. Usually a doctor suspects an injury when the person has had a recent operation or notices a wound that has penetrated the abdomen. People may complain simply of pain in the abdomen or flank, or they may notice urine leaking from their wound. Fever may accompany an infection caused by persistent urinary leakage. Blood may appear in the urine.

When a ureteral injury is suspected, imaging tests are needed. The initial test is often intravenous urography or computed tomography (CT), but if both are inconclusive, retrograde urography may be performed. Sometimes surgery may be needed to identify an injury.

Treatment

If a ureter is injured, surgery is often needed to repair it. Some minor ureteral injuries can be treated by placing a flexible tube either directly in the ureter or through the kidney via a small incision in the side (percutaneous nephrostomy). The purpose of these procedures is to divert urine from flowing through the ureter, usually for 2 to 6 weeks, allowing the ureter to heal. If the ureteral injury does not resolve using this procedure, additional surgery may be needed.

Treatment helps to prevent complications of ureteral injuries. If complications occur despite efforts to prevent them, they must be treated.