Ureteral Trauma Due to Penetrating Missiles
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.
Unable to display preview. Download preview PDF.
- 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
- Bright TC, Peters PC (1977) Ureteral injuries due to external violence. J Trauma 17 Google Scholar
- Holden S, Hicks CC, O’Brien DP III, Stone HH, Walker JA, Walton KN (1976) GunshotGoogle Scholar
- wounds of the ureter: a 15-year review of 63 consecutive cases. J Urol 116:562Google Scholar
- Hulse CA, Sawtelle WW, Nadig PW, Wolff HL (1968) Conservative managment of uretero-vaginal fistula. J Urol 99:42Google Scholar
- 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
- Sampson JA (1902) Report of 16 cases occurring in service of H.A. Kelly at Johns Hopkins Hospital. Am Med 4: 693Google Scholar
- Weaver RG (1958) Ureteral regeneration: experimental and clinical, Part III. J Urol 79:31Google Scholar