Traumas of the ureter. Apropos of 29 cases

The origin of ureteral trauma is often iatrogenic, particularly after gynaecologic surgery, and causes diagnostic and therapeutic problems. The characteristics of this affection are reviewed in a retrospective study of 29 traumatic lesions of the ureter collected over a 17 year period. Three ureteral trauma were by penetrating injury and twenty six were iatrogenic. For the latter, hysterectomy was the principal cause (17 cases). Urine leakage through the vagina was the most frequent clinical symptom (20 cases). In the majority of cases, intravenous urography was sufficient to make the diagnosis. Uretero-hydronephrosis was noticed in 17 cases, and extravasation in 14 cases. The majority of iatrogenic lesions (20 cases) was diagnosed after a one month delay. Lower third of the ureter was the most frequent site of injury in iatrogenic traumas (10 cases), whereas the upper third was the site of predilection of penetrating traumas (3 cases). Four vesico-vaginal fistulaes and two resto-vaginal fistulaes were associated to ureteral iatrogenic lesions. Various therapeutic methods were used. For mid and lower ureteral lesions, psoas-bladder hitch was the most frequent procedure (11 cases). On the other hand, for upper ureteral lesions, ureteral anastomosis was done in three cases. Only one nephrectomy was done, after an iatrogenic lesion diagnosed very late, with a non functioning kidney. We noticed six surgical failures: four after termino-terminal anastomosis, and two after Boari-Küss's procedure. The data of literature concerning etiopathogeny, diagnosis, therapeutic modalities and prevention of traumatic lesions of the ureter and reviewed.