Features of treatment of ureteral injuries

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Choosing the optimal techniques for the treatment of ureteral injuries is necessary. Damage to the ureter accounts for < 3% of cases of injuries of the genitourinary system. More than 70% of iatrogenic ureteric injuries are not detected during surgery. Approximately 75%–80% of ureterotraumas are due to iatrogenic causes, of which 65%–82% are due to gynecological surgeries. Mechanical injuries of the ureter are much less common than iatrogenic ones. Gunshot and stab wounds of the ureter prevail among mechanical injuries. Thirty-one patients who were treated at the I.I. Janelidze Research Institute of Emergency Medicine with various ureteral injuries from 2003 to 2019 were examined. Patients were divided into three groups according to the time of detection of ureteral injury. Group 1 included patients with ureteral injuries identified during surgery, group 2 included those with ureteral injuries diagnosed within 72 h, and group 3 consisted of patients with ureteral injures detected > 72 h later. The choice of treatment techniques for ureterotrauma relied on the general condition of the patient, severity and level of damage to the ureter, timing of its diagnosis, and nature of the complications. On intraoperative detection of ureterotrauma in patients with a stable condition, reconstructive surgery of the ureter should be performed immediately to ensure the passage of urine from the upper urinary tract. If ureterotrauma is diagnosed before 72 h and there are no inflammatory complications, reconstructive ureteral surgery is also appropriate. If an infectious and inflammatory process develops, a staged operation is necessary to drain the upper urinary tract and relieve the developed posttraumatic complications. When ureterotrauma is diagnosed > 72 h later, a staged operation is performed to eliminate complications and drainage of the upper urinary tract. Reconstructive surgery is performed not earlier than after 2 months.

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Gocha S. Shanava

Saint Petersburg I.I. Dzanelidze Research Institute of Emergency Medicine; Almazov National Medical Research Centre

Author for correspondence.
Email: dr.shanavag@mail.ru
SPIN-code: 1706-7410

candidate of medical sciences

Russian Federation, Saint Petersburg; Saint Petersburg

Michail S. Mosoyan

Almazov National Medical Research Centre; Academician I.P. Pavlov First Saint Petersburg State Medical University

Email: moso3@yandex.ru
SPIN-code: 5716-9089
Scopus Author ID: 57041359200

doctor of medical sciences

Russian Federation, Saint-Petersburg; Saint Petersburg

Vladimir V. Protoshchak

Military medical academy of S.M. Kirov

Email: protoshakurology@mail.ru
ORCID iD: 0000-0002-4996-2927
SPIN-code: 6289-4250

doctor of medical sciences, professor

Russian Federation, Saint Petersburg

Igor V. Soroka

Saint Petersburg I.I. Dzanelidze Research Institute of Emergency Medicine

Email: drsoroc@rambler.ru
Scopus Author ID: 560248
Russian Federation, Saint Petersburg

Anastasia D. Nalivaiko

Military medical academy of S.M. Kirov

Email: nastenka.nalivayko@mail.ru
SPIN-code: 6157-8394
Russian Federation, Saint Petersburg

Dmitriy G. Putrenok

Saint Petersburg I.I. Dzanelidze Research Institute of Emergency Medicine

Email: petite_femme061294@mail.ru
SPIN-code: 6278-2122
Russian Federation, Saint Petersburg

Dmytriy N. Orlov

Military medical academy of S.M. Kirov

Email: d.n.orlov@mail.ru
Russian Federation, Saint Petersburg


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Supplementary files

Supplementary Files
1. Fig. 1. Gunshot wound of the left ureter

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2. Fig. 2. Endoclipation of the upper third of the left ureter during laparoscopic hemicolectomy

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Copyright (c) 2022 Shanava G.S., Mosoyan M.S., Protoshchak V.V., Soroka I.V., Nalivaiko A.D., Putrenok D.G., Orlov D.N.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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