Ureteral trauma: Patterns and mechanisms of injury of an uncommon condition

Siram, Suryanarayana M.; Gerald, Sonja Z.; Greene, Wendy R.; Hughes, Kakra; Oyetunji, Tolulope A.; Chrouser, Kristin; Cornwell, Edward E.; Chang, David C.

doi:10.1016/j.amjsurg.2009.11.001

« Previous Next »The American Journal of Surgery
Volume 199, Issue 4 , Pages 566-570, April 2010

Ureteral trauma: Patterns and mechanisms of injury of an uncommon condition

Presented at the 19th Annual Scientific Session of the Society of Black Academic Surgeons, April 2–4, 2009, Seattle, WA.

Suryanarayana M. Siram, M.D.
- Department of Surgery, Howard University College of Medicine, 2041 Georgia Avenue, NW, Washington, DC 20060, USA
- Corresponding author: Tel.: +1-202-865-1285; fax: +1-202-865-7089
Sonja Z. Gerald, M.B.A.
- Department of Surgery, Howard University College of Medicine, 2041 Georgia Avenue, NW, Washington, DC 20060, USA
Wendy R. Greene, M.D.
- Department of Surgery, Howard University College of Medicine, 2041 Georgia Avenue, NW, Washington, DC 20060, USA
Kakra Hughes, M.D.
- Department of Surgery, Howard University College of Medicine, 2041 Georgia Avenue, NW, Washington, DC 20060, USA
Tolulope A. Oyetunji, M.D., M.P.H.
- Department of Surgery, Howard University College of Medicine, 2041 Georgia Avenue, NW, Washington, DC 20060, USA
Kristin Chrouser, M.D., M.P.H.
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Edward E. Cornwell III, M.D.
- Department of Surgery, Howard University College of Medicine, 2041 Georgia Avenue, NW, Washington, DC 20060, USA
David C. Chang, Ph.D., M.P.H., M.B.A.
- Department of Surgery, Howard University College of Medicine, 2041 Georgia Avenue, NW, Washington, DC 20060, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA

Received 11 May 2009; received in revised form 20 November 2009

Abstract

Background

Traumatic ureteral injuries are uncommon, thus large series are lacking.

Methods

We performed a retrospective analysis of the National Trauma Data Bank (2002–2006).

Results

Of the 22,706 genitourinary injuries, 582 ureteral injury patients were identified (38.5% blunt, 61.5% penetrating). Patients were 84% male, 38% white, and 37% black (mean age, 31 y). Blunt trauma patients had a median Injury Severity Score of 21.5 versus 16.0 for penetrating injury (P < .001). Mortality rates were 9% blunt, and 6% penetrating (P = .166). Penetrating trauma patients had a higher incidence of bowel injuries (small bowel, 46%; large bowel, 44%) and vascular injuries (38%), whereas blunt trauma patients had a higher incidence of bony pelvic injuries (20%) (P < .001).

Conclusions

Ureteral injuries are uncommon, seen in approximately 3 per 10,000 trauma admissions, and occur more in penetrating than in blunt trauma. The most common associated injury for blunt ureteral trauma is pelvic bone fracture, whereas penetrating ureteral trauma patients have more hollow viscus and vascular injuries.

Keywords: Ureteral trauma, Ureter, National Trauma Data Bank