Non-Iatrogenic Ureteric Injuries in Children: Single Center Experience

Abstract

Purpose Non-iatrogenic ureteral injuries include those resulting from blunt trauma, stab wounds and gunshot wound. This type of ureteric trauma is extremely rare, occurring in 1% of all genitourinary trauma. We reviewed our experience in diagnosis and treatment of non-iatrogenic ureteric injuries in children over 15 years. Material and Methods From 1990 to 2005, ten children were treated for non-iatrogenic ureteric injuries. Patients characteristics, mechanism of trauma, affected ureteric segment, time of recognition, associated injuries, presentation, mode of treatment and postoperative complications were studied from the medical records of those patients. Results Ten non-iatrogenic ureteral injuries were repaired over 15 years. Five males and 5 females with median age 8 years (range 2-16). Right side was affected in 6 children. Blunt abdominal trauma was accused in 8 children while in two children penetrating trauma was inflicted (stab wound). Associated injuries were documented in 4 children- two of the penetrating trauma and two from the 8 blunt trauma. The affected segment was PUJ in 7 children, mid ureter in 2 and juxtavesical in one child. Urinoma was the presentation in all cases and diagnosis was established by reterograde pyelography in 4 children while PCN and antegrade pyelography in the others. In 4 children to whom retrograde pyelography was done, JJ stent was applied for 3 months in addition to percutaneous drain in 2 while ureterovesical reimplantation and A-H pyeloplasty in the others. In children to whom percutaneous nephrostomy was performed for 3-6 months, three necessitate nephrectomy for non functioning kidneys, two were treated by ureterocalyceal anastomosis and the other child was managed by ureteroureterostomy. Conclusions Pediatric non-iatrogenic ureteral injuries are extremely rare but can be devastating and/or challenging according to the subsequent fibrosis and the state of kidney function and also delay in diagnosis of those patients will increase the risk of complications.