[Ureter injuries. Apropos of 42 cases]

Abstract

Ureteric trauma constitutes a serious disease which can induce renal complications. Ureteric trauma is often iatrogenic, mainly due to gynaecological surgery. The authors report a series of 42 cases of ureteric trauma observed over a 20-year period. These patients consisted of 33 females (78%) and 9 males (21%) with a mean age of 38 years (range: 20 to 65 years). 24 ureteric lesions (57%) were secondary to obstetric procedures and operations, 9(21%) were due to gynaecological operations (hysterectomy), ureteroscopy was responsible in 3 cases, 2 lesions were due to lumbar sympathectomy, one case was secondary to resection of the rectum and 2 cases were secondary to abdominal trauma. The most frequent lesion was ureteric section (21 cases), usually affecting the pelvic ureter. Iatrogenic lesions were associated with iliac vessel ligation (1 case) and vesicovaginal fistulas (8 cases). The clinical features were dominated by vaginal urinary fistula (33 cases) and low back pain (15 cases). The diagnosis was essentially based on IVU, which showed ureterohydronephrosis in 18 cases and a silent kidney in 2 cases. Eight ureteric lesions were diagnosed at operation, 31 after an interval of 3 to 20 days and 2 after an interval of 3 months. Treatment consisted of ureterovesical reimplantation in 17 cases, Boari-Kuss bladder flap in 3 cases, psoas bladder in 6 cases, end-to-end ureterorraphy in 5 cases, ileoureteroplasty in 3 cases, nephrectomy in 2 cases, appendicoplasty in 1 case, double J stent in 2 cases. The course was marked by the development of hydronephrosis (4 cases), ureteric stenosis (2 cases), vesico-ureteric reflux (1 case), urinary fistula (2 case) and lengthening of the ileal graft (1 case).