Xia Mancheng, Li Xinfei, Zhao Fangzhou, Jiao Pengcheng, Li Zhihua, Xiong Shengwei, Zhang Peng, Wang Bing, Zhu Hongjian, Yang Kunlin, Zhou Liqun, Zhang Kai, Li Xuesong
Department of Urology, Peking University First Hospital, Beijing, China.
Institution of Urology, Peking University, Beijing, China.
Ther Adv Urol. 2024 Dec 13;16:17562872241297541. doi: 10.1177/17562872241297541. eCollection 2024 Jan-Dec.
Traumatic ureteral injury is a rare and challenging condition of the urinary system. To summarize the clinical features of patients with traumatic ureteral injury and examine the literature on traumatic ureteral injuries from the past 20 years. The clinical data of 30 patients with traumatic ureteral injury in Peking University First Hospital, Beijing Jiangong Hospital, as well as Emergency General Hospital from August 2015 to August 2023 were retrospectively collected. The clinical characteristics, management strategies, and follow-up outcomes were analyzed, and a review of the literature on traumatic ureteral injury from the past 20 years was conducted. The traumatic types in the case series was composed of sharp injury, impact injury, and falling injury, with 9, 16, and 5 cases, respectively. Ureteral injury was diagnosed immediately in 12 cases, while 18 cases had a delayed diagnosis. Besides, the median time from ureteral injury to operations was 8.5 months (IQR: 4-13 months) in the patients who received upper urinary tract repair surgery, including ureteral stenting in one case, ureteroureterostomy in four cases, pyeloplasty in two cases, lingual mucosal graft ureteroplasty in one case, ileal ureter replacement in five cases, and nephrectomy in one cases. The mean follow-up time is 39.1 ± 24.8 months. Concerning renal function, postoperative creatinine was substantially lower than preoperative one (78.6 ± 13.7 µmol/L vs 88.8 ± 17.0 µmol/L, = 0.0009), and postoperative urea was significantly lower than preoperative one (4.6 ± 1.6 µmol/L vs 5.9 ± 1. 3 mmol/L, = 0.0016). Traumatic ureteral injury is challenging to recognize due to its deep anatomical location, making timely diagnosis crucial. It is important to choose an appropriate reconstruction method based on severity, location, length to restore urinary tract continuity as early as possible.
创伤性输尿管损伤是泌尿系统一种罕见且具有挑战性的病症。为总结创伤性输尿管损伤患者的临床特征，并查阅过去20年有关创伤性输尿管损伤的文献。回顾性收集了北京大学第一医院、北京建工医院以及应急总医院2015年8月至2023年8月期间30例创伤性输尿管损伤患者的临床资料。分析了临床特征、治疗策略及随访结果，并对过去20年有关创伤性输尿管损伤的文献进行了综述。病例系列中的创伤类型包括锐器伤、撞击伤和坠落伤，分别为9例、16例和5例。12例患者输尿管损伤得到立即诊断，18例为延迟诊断。此外，接受上尿路修复手术的患者中，从输尿管损伤到手术的中位时间为8.5个月（四分位间距：4 - 13个月），其中1例患者接受输尿管支架置入术，4例接受输尿管输尿管吻合术，2例接受肾盂成形术，1例接受舌黏膜移植输尿管成形术，5例接受回肠代输尿管术，1例接受肾切除术。平均随访时间为39.1±24.8个月。关于肾功能，术后肌酐显著低于术前（78.6±13.7µmol/L对88.8±17.0µmol/L，P = 0.0009），术后尿素也显著低于术前（4.6±1.6µmol/L对5.9±1.3mmol/L，P = 0.0016）。由于创伤性输尿管损伤的解剖位置较深，其识别具有挑战性，因此及时诊断至关重要。根据损伤严重程度、位置、长度选择合适的重建方法以尽早恢复尿路连续性很重要。
