Jozef Marenčák, Eduard Králik, Patrícia Rusková, Lenka Kotorová, Michaela Trabalíková
Introduction: Injuries of ureter consist of 1.0 – 2.5 % of urinary tract injuries.
Objective: Retrospective analysis of diagnostic methods and the effectiveness of treatment of patients with injuries to
Materials and methods: In the period from 1 Jan 1985 to 31 Dec 2015 33 individuals (average age 36.9 years, range 16-
71 years) with injuries to the ureter were examined and treated. The diagnosis was established on the basis of: history,
physical (and intraoperative) examination, imaging studies, laboratory tests, and so on. Blunt ureter injuries were
noted in 3/33 (9.1 %), penetrating the 3/33 (9.1 %), as a part of polytrauma in 10/33 (30.3 %), and iatrogenic in 17/33
(51.5 %). The upper ureter has been affected by the accident in a 4/33 (12.1 %), moderate in 9/33 (27.3 %), and the lower
ureter 20/33 (60.6 %). Traumas of ureters were classified according to five degrees of injury severity. One patient had
solitaire kidney since birth and in another one the contralateral, hypoplastic (injuries uninvolved) kidney was found.
A method of treatment was due to several factors and included as endoscopy, as well as operational procedures. Mean
follow-up of patients amounted to 48.5 (range 3-79) months.
Results: Time to therapeutic solutions was minimal - a few hours in blunt, penetrative and polytraumatic injuries (16/33
= 48.5 % of patients). Hematuria was present in only 7/16 (43.8 %) affected. Nephrectomy in this subgroup was indicated
twice - concurrent to unstoppable bleeding from the kidney. Intraoperative detection and the solution of iatrogenic
damage of the ureter was made in 6/17 (35.3 %), in 2/17 (11.8 %) definitive treatment was initiated within 48 hours
and in 9/17 (52.9 %) the correct diagnosis was made after 15 (range 7 – 90) days after the procedure. The most common
symptoms were: flank pain, fever, peritoneal irritation, hematuria but only in 3/9 (333 %) patients. Therapeutically
in these cases there was made temporary drainage of the kidney (percutaneous nephrostomy in particular, but also
ureteric stenting) and definitive treatment (ureteroureterostomy, ureteropyelostomy, ureteroneocystostomy, etc.)
was carried out with a time interval. Nephrectomy was necessary once due to non-functioning kidney, and multiple septic
temperatures. In the group of late diagnosed ureteral trauma there was a significant decrease (on average 25 %) the
separate renal function and there was a higher number of complications (stricture of the urethra, urinary tract infections,
etc.). compared to intraoperatively identify and resolve injuries.
Conclusions: The diagnosis and treatment of ureteric injuries depends on several factors. Iatrogenic injury of the ureters
are now not only the most common, but largely they are diagnosed late, which reduces the efficiency of treatment
and increases the number of subsequent complications.