Rupture of ureter at uretero-pelvic junction.
1. Stabilization and transport from field via EMS. Transported to Gettysburg Hospital >York Hospital > Johns Hopkins Urology (JHU)
2. JHU passed a nephroureteral stent Case Photo #4through the affected area from the outside; no urostomy bag, instead change a dressing once a day and flush stent twice a day from external port; followed weekly at JHU.
10/21/14: fever and dysuria with 2+ LE, diagnosed with UTI but remote possibility of pyelonephritis and placed on ciprofloxacin; symptoms resolved by 10/27.
All stents/tubes removed early November, serial ultrasounds kidney/spleen OK, resumed soccer in spring! Followed with annual sono kidney/spleen. OK for contact sports.
There aren't many case studies for review on ureteral injuries and they may up less than 1% of all urinary tract injuries. Neither CT nor IVP acutely has been found to be reliable in the detection of ureteral injuries. In a retrospective review of five patients with ureteral injuries secondary to blunt trauma, 80% of injuries were missed on initial CT and detected only on delayed CT 24 hours later. One study suggests delaying spiral CT for five to eight minutes after contrast infusion to increase the sensitivity in detecting ureteropelvic junction disruption from blunt trauma.Another review of 12 ureteral injuries, the authors concluded that since ureteral injuries are infrequent and few surgeons have significant experience with their management, a high index of suspicion is required during celiotomy.
Holevar, M et al. "Genitourinary Trauma, Diagnostic Evaluation of". Eastern Association for the Surgical of Trauma publication, 2003.
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