Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt.
Int Urol Nephrol. 2011 Mar;43(1):1-5. doi: 10.1007/s11255-010-9766-z. Epub 2010 Jun 6.
Non-iatrogenic ureteral injuries in children are rare. Only sparse literature reports are available regarding management and outcome. We reviewed our experience in diagnosis and treatment of complex non-iatrogenic ureteral injuries in children.
From 2000 to 2010, children who were treated for non-iatrogenic ureteral injuries were reviewed. Patients' characteristics, mechanism of trauma, affected ureteral segment, time of recognition, associated injuries, presentation, mode of treatment and postoperative complications were studied from the medical records of those patients.
Five children (four boys and one girl) with a median age of 10 (range 2-15) were treated at our center. Blunt abdominal trauma was documented in three children, while in another two penetrating trauma was inflicted. Associated hepatic tear was noted in one child and bowel injury in another. The affected segment was UPJ in three and mid-ureter in two. All cases presented with Urinoma. Diagnosis was confirmed after fixation of percutaneous nephrostomy and antegrade pyelography in four children, while reterograde pyelography was done in the remaining child. Surgical interventions included uretero-calyceal anastomosis in two, while nephrectomy was necessitated in another two with poor kidney function. In the child to whom retrograde pyelography was done, a double J stent was fixed for 3 months and the patient did well.
Pediatric non-iatrogenic ureteral injuries are rare. A raised index for suspicion should be considered intra-operatively during initial exploration. Missed injuries are more common and may end in dense scarring and up to nephrectomy.
儿童非医源性输尿管损伤罕见。仅有少量文献报道此类疾病的治疗方法和结果。我们回顾了我院治疗儿童复杂非医源性输尿管损伤的经验。
回顾 2000 年至 2010 年期间，在我院接受治疗的非医源性输尿管损伤患儿的临床资料。从病历中总结患儿的一般情况、外伤机制、损伤的输尿管节段、诊断时间、合并伤、临床表现、治疗方法及术后并发症。
5 例患儿（男 4 例，女 1 例），年龄中位数为 10 岁（2-15 岁）。3 例患儿为钝性腹部外伤，2 例为穿透性外伤。1 例患儿合并肝撕裂伤，1 例合并肠损伤。3 例损伤位于肾盂输尿管连接部，2 例位于输尿管中段。所有患儿均表现为尿囊肿。4 例患儿通过固定经皮肾造瘘管和顺行肾盂造影明确诊断，1 例患儿通过逆行肾盂造影诊断。手术治疗包括输尿管肾盂吻合术 2 例，2 例因肾功能不良行肾切除术。对于行逆行肾盂造影的患儿，留置双 J 管 3 个月，恢复良好。
儿童非医源性输尿管损伤罕见。初次探查时应提高术中对此病的警惕性，避免漏诊。如果漏诊，可能会导致严重的输尿管狭窄，甚至需要肾切除术。
