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GUNSHOT WOUNDS TO THE URETER: A 40-YEAR EXPERIENCE AT GRADY MEMORIAL HOSPITAL

2001; Lippincott Williams & Wilkins; Volume: 166; Issue: 1 Linguagem: Inglês

10.1016/s0022-5347(05)66089-2

1527-3792

Marcos Perez-Brayfield, Thomas E. Keane, Anand Krishnan, PAUL LAFONTAINE, David V. Feliciano, Harry S. Clarke,

Abdominal Trauma and Injuries

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jul 2001GUNSHOT WOUNDS TO THE URETER: A 40-YEAR EXPERIENCE AT GRADY MEMORIAL HOSPITAL MARCOS R. PEREZ-BRAYFIELD, THOMAS E. KEANE, ANAND KRISHNAN, PAUL LAFONTAINE, DAVID V. FELICIANO, and HARRY S. CLARKE MARCOS R. PEREZ-BRAYFIELDMARCOS R. PEREZ-BRAYFIELD , THOMAS E. KEANETHOMAS E. KEANE , ANAND KRISHNANANAND KRISHNAN , PAUL LAFONTAINEPAUL LAFONTAINE , DAVID V. FELICIANODAVID V. FELICIANO , and HARRY S. CLARKEHARRY S. CLARKE View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)66089-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Because of the morbidity associated with missed ureteral injuries, a high index of suspicion must be present to diagnose this type of injury. We reviewed our 40 years of trauma experience at Grady Memorial Hospital. Materials and Methods: We retrospectively reviewed the records of 118 patients with ureteral injuries secondary to a gunshot wound to the ureter from 1960 to 1999. All cases were reviewed for the mechanism of injury, location, initial urinalysis, imaging modalities, associated injuries, operative procedures and complications. Results: Our population consisted of patients 14 to 71 years old, of whom 66 had right ureteral, 51 had left ureteral and 1 had bilateral injury. Urinalysis revealed no evidence of blood in the urine in 15% of the patients in whom the test was performed. Excretory urography had a false-negative rate of 33%. The injury was located at the proximal, mid and distal ureter in 43, 38 and 37 cases, respectively. Multiple surgical approaches were used depending on the location and severity of the defect. Only 1 patient had an isolated ureteral injury, while the remainder had associated injuries. Complications were present in 24 cases. Conclusions: To our knowledge this series of ureteral injuries is the largest reported to date. Because preoperative urinalysis and imaging studies are unreliable for ruling out injury, a high index of suspicion must be present. Furthermore, a predefined trauma protocol, as defined in our algorithm, decreases the number of missed ureteral injuries that may potentially complicate the outcome of an already critical case. References 1 : Reconstructive surgery for trauma of the upper urinary tract. Urol Clin North Am1999; 26: 183. Google Scholar 2 : Gunshot wounds of the ureter: a 15-year review of 63 consecutive cases. J Urol1976; 116: 562. Link, Google Scholar 3 : Penetrating ureteral trauma at an urban trauma center: 10-year experience. Urology1999; 54: 34. Google Scholar 4 : Gunshot injuries of the ureter. J Trauma1990; 30: 83. Google Scholar 5 : The initial management of ureteral injuries: a case report of 78 cases. J Urol1971; 105: 340. 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Google Scholar From the Departments of Urology and General Surgery, Emory University Hospital and Grady Memorial Hospital, Atlanta, Georgia© 2001 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByKunkle D, Kansas B, Pathak A, Goldberg A and Mydlo J (2018) Delayed Diagnosis of Traumatic Ureteral InjuriesJournal of Urology, VOL. 176, NO. 6, (2503-2507), Online publication date: 1-Dec-2006.BEST C, PETRONE P, BUSCARINI M, DEMIRAY S, KUNCIR E, KIMBRELL B and ASENSIO J (2018) TRAUMATIC URETERAL INJURIES: A SINGLE INSTITUTION EXPERIENCE VALIDATING THE AMERICAN ASSOCIATION FOR THE SURGERY OF TRAUMA-ORGAN INJURY SCALE GRADING SCALEJournal of Urology, VOL. 173, NO. 4, (1202-1205), Online publication date: 1-Apr-2005.ELLIOTT S and McANINCH J (2018) Ureteral Injuries From External Violence: The 25-Year Experience At San Francisco General HospitalJournal of Urology, VOL. 170, NO. 4 Part 1, (1213-1216), Online publication date: 1-Oct-2003. Volume 166Issue 1July 2001Page: 119-121 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.Keywordswoundswounds and injuriesuretergunshotdiagnosisMetricsAuthor Information MARCOS R. PEREZ-BRAYFIELD More articles by this author THOMAS E. KEANE More articles by this author ANAND KRISHNAN More articles by this author PAUL LAFONTAINE More articles by this author DAVID V. FELICIANO More articles by this author HARRY S. CLARKE More articles by this author Expand All Advertisement PDF DownloadLoading ...