EARLY SURGICAL MANAGEMENT OF URETERAL TRAUMA
Authors:
Jana Hlaváčová 1; Jan Jambura 1; Jiří Kouba 1; Jan Bulka 2; Viktor Eret 1; Milan Hora 1
Authors‘ workplace:
Urologická klinika LF UK a FN, Plzeň
1; Radiodiagnostické oddělení FN, Plzeň
2
Published in:
Ces Urol 2011; 15(3): 158-166
Category:
Original article
Overview
Aim:
We summarized our own experience and results of early surgical management of ureteral trauma (UT).
Methods:
In the period between January 1995 and January 2010 we treated 71 patients (15 men and 56 women) for UT. We evaluated our cohort in regard of advantage of indication of early surgical management. This is a retrospective study.
Results:
The mean age was 47 years (range 33–66). The most common cause of UT were gynaecological procedures (43%), less often endoscopical procedures (28%), colorectal operations (18%), ureter deliberations (5%), surgery of abdominal aortic aneurysm (3%), suprapubic prostatectomy (1.5%) and penetrating bullet trauma (1.5%). The UT was diagnosed by urine leakage into the operative wound in 18 cases, into the retroperitoneum in 16 cases, into the abdominal cavity 6 times and into the vagina 9 times. An obstruction causing the megaureter above was found in 19 cases, 2 times non-functioning kidney and once an anuria caused by bilateral ligature of ureters. As a surgical management of UT, there was indicated ureterocystostomy in 21 cases (15× early and 6× delayed), Boari bladder flap technique 6× (5× early and once delayed), 14× suture of the ureter (always peroperatively), 4× ureterorhaphy (3× early and once delayed), 1× substitution of ureter loop of small intestine(early) 2× nephrectomy (delayed), 10× nephrostomy (9× early and once delayed), 13× retrograde ureteral stent placement (11× early and 2× delayed).
Conclusion:
Regardless of the chosen method of treatment in our group it was possible to address the UT early (within one week after the correct diagnosis) in 58 patients (81.7%). This early access to definitive treatment of the UT we proved. The patient benefits in particular shortening of the treatment. The ultimate determination of advantage of early surgical treatment of UT, would have required a prospective randomized study.
Key words:
Boari bladder flap, intravenous pyelography, nephrectomy, ureteral trauma, retrograde ureteral stent placement, ureteroneocystostomy.
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Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2011 Issue 3
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