Ureteral trauma: Patterns and mechanisms of injury of an uncommon condition

doi:10.1016/j.amjsurg.2009.11.001

The American Journal of Surgery

Volume 199, Issue 4, April 2010, Pages 566-570

Presented at the 19th Annual Scientific Session of the Society of Black Academic Surgeons, April 2–4, 2009, Seattle, WA.

https://doi.org/10.1016/j.amjsurg.2009.11.001 Get rights and content

Abstract

Background

Traumatic ureteral injuries are uncommon, thus large series are lacking.

Methods

We performed a retrospective analysis of the National Trauma Data Bank (2002–2006).

Results

Of the 22,706 genitourinary injuries, 582 ureteral injury patients were identified (38.5% blunt, 61.5% penetrating). Patients were 84% male, 38% white, and 37% black (mean age, 31 y). Blunt trauma patients had a median Injury Severity Score of 21.5 versus 16.0 for penetrating injury (P < .001). Mortality rates were 9% blunt, and 6% penetrating (P = .166). Penetrating trauma patients had a higher incidence of bowel injuries (small bowel, 46%; large bowel, 44%) and vascular injuries (38%), whereas blunt trauma patients had a higher incidence of bony pelvic injuries (20%) (P < .001).

Conclusions

Ureteral injuries are uncommon, seen in approximately 3 per 10,000 trauma admissions, and occur more in penetrating than in blunt trauma. The most common associated injury for blunt ureteral trauma is pelvic bone fracture, whereas penetrating ureteral trauma patients have more hollow viscus and vascular injuries.

Section snippets

Patients and Methods

A retrospective analysis of National Trauma Database (NTDB) 7.0 was performed for the years 2002 to 2006. The NTDB is the largest collection of trauma data in the world, with approximately 1.8 million records from nearly 700 US trauma centers. Data from the NTDB is de-identified to comply with the Health Insurance Portability and Accountability Act (HIPAA) regulations. This study was exempt from institutional review board approval.

Inclusion criteria for ureteral injury were International

Results

Of the 22,706 genitourinary trauma injuries recorded in the database (including kidney, ureter, bladder, and urethra), a total of 582 patients were identified with ureteral injuries. Overall, the mean age was 31 years. These patients were predominantly male (84%), with 38% white, 37% black, 18% Hispanic, and 7% other. The median ISS for all patients was 16.5.

Table 1 presents the comparison of demographic data of blunt versus penetrating ureteral trauma cases. There were 224 (38%) blunt and 358

Comments

This was a large study of ureteral injury. Historically, the incidence of ureteral injury caused by noniatrogenic trauma is low. The largest known series before this report included 118 patients over a 40-year period at a single institution.¹⁵ Our retrospective analysis of the NTDB concurs with previously published data, which showed that most ureteral injuries are caused by penetrating trauma (62%), with the vast majority (55%) being associated with gunshot wounds. It has been estimated that

Conclusions

Ureteral injuries are relatively uncommon, and are seen in approximately 3 per 10,000 trauma admissions. Ureteral injury occurs more commonly in penetrating than in blunt trauma (a ratio of approximately 2:1). The most common injury associated with blunt ureteral trauma is damage to the pelvic bone and lumbosacral spine injuries, whereas penetrating ureteral trauma patients are more likely to have hollow viscus and vascular injuries.

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The Society of Black Academic SurgeonUreteral trauma: Patterns and mechanisms of injury of an uncommon condition

Abstract

Background

Methods

Results

Conclusions

Section snippets

Patients and Methods

Results

Comments

Conclusions

Clin Radiol

J Urol

Urology

J Urol

J Am Coll Surg

Urology

Urology

J Urol

Urology

Urology

J Urol

The Society of Black Academic Surgeon
Ureteral trauma: Patterns and mechanisms of injury of an uncommon condition