Ureteral Trauma Due to Penetrating Missiles

  • P. C. Peters
  • T. C. BrightIII
  • R. G. KibbeyIII
Part of the Handbuch der Urologie · Encyclopedia of Urology book series (HDBUROL, volume 14)


Ureteral injury secondary to penetrating weapons has been described as rare. Fisher et al. (1972), in reviewing the literature in 1971, found 123 ureteral injuries secondary to gunshot wounds, including only 33 reported during World War II. Culp (1947) reported an incidence of ureteral injury as 3.75% out of 160 urogenital injuries during World War II. Holden et al. (1976) reported 63 cases in 1976. Our series is composed of 59 cases of ureteral injury secondary to external violence over a 10-year period (Bright and Peters, 1977). The reasons for infrequent injury are: (1) the ureter is a small tubular organ surrounded by loose retroperitoneal fat and connective tissue which allows great mobility; (2) its depth in the retroperitoneal fossa makes it quite inaccessible to any except major injury; (3) it is protected by thick surrounding structures, e.g., the vertebral column medially, the psoas and paraspinal muscles posteriorly and laterally, and the peritoneum with its contents anteriorly. The course of the ureter is depicted in Fig. 1.


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  1. Boari A (1895) Chirurgia dell’ uretere, con prefazience de Dott: I. Albarran, 1,900 Contributi sperimentali alla plastica dell’ uretere, Atti Accad Med Ferrara 14: 444Google Scholar
  2. Bright TC, Peters PC (1977) Ureteral injuries due to external violence. J Trauma 17 Google Scholar
  3. Carlton CE, Scott R, Guthrie AG (1971) The initial management of ureteral injuries: a report of 78 cases. J Urol 105: 335PubMedGoogle Scholar
  4. Culp OS (1947) War wounds of the genitourinary tract. J Urol 57: 1117PubMedGoogle Scholar
  5. Demuth WE Jr (1966) Bullet velocity and design as determinates of wounding capability: an experimental study. J Trauma 6: 222PubMedGoogle Scholar
  6. Demuth WE Jr (1969) Bullet velocity as applied to military rifle wounding capacity. J Trauma 9: 27PubMedCrossRefGoogle Scholar
  7. Fisher S, Young DA, Malin JM, Pierce JM (1972) Ureteral gunshot wounds. J Urol 108: 238PubMedGoogle Scholar
  8. Harrow BR (1969) Management of ureteral injuries causing anuria. J Urol 101: 694PubMedGoogle Scholar
  9. Herman G, Guerrier K, Persky L (1972) Delayed ureteral deligation. J Urol 107: 723PubMedGoogle Scholar
  10. Higgins CC (1962) Ureteral injuries. JAMA 182: 225PubMedCrossRefGoogle Scholar
  11. Hinman F (1957) Ureteral repair and the splint. J Urol 78: 376PubMedGoogle Scholar
  12. Hoch WH, Kursh L, Persky L (1975) Early aggressive management of intraoperative ureteral injuries. J Urol 114: 530PubMedGoogle Scholar
  13. Hodges CV, Moore RJ, Lehman TH, Benham AM (1963) Clinical experience with transureteroureterostomy. J Urol 90: 552PubMedGoogle Scholar
  14. Holden S, Hicks CC, O’Brien DP III, Stone HH, Walker JA, Walton KN (1976) GunshotGoogle Scholar
  15. wounds of the ureter: a 15-year review of 63 consecutive cases. J Urol 116:562Google Scholar
  16. Hulse CA, Sawtelle WW, Nadig PW, Wolff HL (1968) Conservative managment of uretero-vaginal fistula. J Urol 99:42Google Scholar
  17. Mannes H, Zimskind P, Subbarao Y, Lewis PL (1972) Crush injury to the lower ureter: an experimental study. J Urol 108: 548PubMedGoogle Scholar
  18. Newell QU (1939) Injuries to ureters during pelvic operations. Ann Surg 109: 981PubMedCrossRefGoogle Scholar
  19. Orkin LA (1964) Trauma to the ureter: pathogenesis and management. FA Davis, Philadelphia Peters PC, Bright TC (1976) Management of trauma to the urinary tract. In: Advances in surgery, vol 10. Year Book Medical Publishers, Chicago, LondonGoogle Scholar
  20. Peterson DC, Lucey DT, Fired FA (1974) Nonsurgical management of uretervaginal fistula. Urol 4: 677PubMedCrossRefGoogle Scholar
  21. Politano VA, Leadbetter WF (1958) An operative technique for the correction of vesicoureteral reflux. J Urol 79: 932PubMedGoogle Scholar
  22. Pridgen WR, Woodhead DM, Younger RK (1961) Alterations in renal function produced by ureteral obstruction. JAMA 178: 563PubMedCrossRefGoogle Scholar
  23. Sampson JA (1902) Report of 16 cases occurring in service of H.A. Kelly at Johns Hopkins Hospital. Am Med 4: 693Google Scholar
  24. Scott FB, Greenberg M (1972) Submucosal bladder flap ureteroplasty: clinical experience. South Med J 65: 1308PubMedCrossRefGoogle Scholar
  25. Spence HM, Boone TB (1958) Injuries of the ureter due to external violence. Am Surg 24: 423PubMedGoogle Scholar
  26. Spence HM, Boone T (1961) Surgical injuries to the ureter. JAMA 176: 1070CrossRefGoogle Scholar
  27. Staubitz WJ, Magoss IV, Melbourne HL, Sigman EM, Oberkircher OV (1959) Management of ureteral injuries. JAMA 171: 1296CrossRefGoogle Scholar
  28. St Martin E, Tricher BE, Campbell JH, Locke CM (1953) Ureteral injuries in gynecologic surgery. J Urol 70: 51PubMedGoogle Scholar
  29. Valk WL, Foret JD (1959) The problem of vesico-vaginal and uretero-vaginal fistulas. Med Clin North Am 43: 1769PubMedGoogle Scholar
  30. Weaver RG (1958) Ureteral regeneration: experimental and clinical, Part III. J Urol 79:31Google Scholar
  31. Weinberg SR, Hamm FC, Berman B (1960) The management and repair of lesions of the ureter with fistula. Surg Gynecol Obstet 110: 575PubMedGoogle Scholar
  32. Wertheim E (1901) Ein neuer Beitrag zur Frage der Radikaloperation beim Uteruskrebs. Arch Gynaek 65: 1CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1981

Authors and Affiliations

  • P. C. Peters
  • T. C. BrightIII
  • R. G. KibbeyIII

There are no affiliations available

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