URETERAL TRAUMA BASED ON A SERIES OF 42 C ASES

Ureteric trauma constitutes a serious disease which can induce renal c omplications. Ureteric trauma is often iatrogenic, mainly due to gynae cological surgery. The authors report a series of 42 cases of ureteric trauma observed over a 20-year period: These patients consisted of 33 females (78%) and 9 males (21%) with a mean age of 38 years (range: 2 0 to 65 years). 24 ureteric lesions (57%) were secondary to obstetric procedures and operations, 9 (21%) were due to gynaecological operatio ns (hysterectomy), ureteroscopy was responsible in 3 cases, 2 lesions were due to lumbar sympathectomy, one case was secondary to resection of the rectum and 2 cases were secondary to abdominal trauma. The most frequent lesion was ureteric section (21 cases), usually affecting th e pelvic ureter. Iatrogenic lesions were associated with iliac vessel ligation (1 case) and vesicovaginal fistulas (8 cases). The clinical f eatures were dominated by vaginal urinary fistula (33 cases) and low b ack pain (15 cases). The diagnosis was essentially based on IVU, which showed ureterohydronephrosis in 18 cases and a silent kidney in 2 cas es. Eight ureteric lesions were diagnosed at operation, 31 after an in terval of 3 to 20 days and 2 after an interval of 3 months. Treatment consisted of ureterovesical reimplantation in 17 cases, Boari-Kuss bla dder flap in 3 cases, psoas bladder in 6 cases, end-to-end ureterorrap hy in 5 cases, ileoureteroplasty in 3 cases, nephrectomy in 2 cases, a ppendicoplasty in 1 case, double J stent in 2 cases. The course was ma rked by the development of hydronephrosis (4 cases), ureteric stenosis (2 cases), vesico-ureteric reflux(1 case), urinary fistula (2 case) a nd lengthening of the ileal graft (1 case).