Ureteral Trauma Clinical Presentation

Updated: Jan 24, 2020
  • Author: Richard A Santucci, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Presentation

History

The key to managing any ureteral injury, regardless of its etiology, is maintaining a high index of suspicion.

Most iatrogenic injuries (70%-80%) are diagnosed postoperatively. The presenting signs and symptoms may include the following [15] :

  • Flank pain (36%-90%)
  • Fever and sepsis (10%)
  • Fistula (ureterovaginal and/or ureterocutaneous)
  • Urinoma
  • Prolonged ileus
  • Renal failure secondary to bilateral obstruction (10%)

Other rare but reported injuries include an aortoureteric or graft-ureteric fistula, which may present as mild-to-massive gross hematuria, or a silent obstruction, which can present later as hypertension and nephrotic syndrome.

In patients with external trauma, ureteral involvement may not be obvious, especially when associated with multiorgan involvement. Therefore, the diagnosis of a ureteral injury may be delayed as other critical injuries are addressed. Nevertheless, as discussed above, a high index of suspicion for ureteral involvement must be maintained.

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Physical Examination

Again, with the patient's history in mind, a carefully performed physical examination may be revealing. The following findings are especially suggestive:

  • An abdominal or flank mass
  • Costovertebral angle tenderness
  • Peritoneal signs
  • Fluid drainage from the wound or vagina
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