International Urology and Nephrology

, Volume 43, Issue 1, pp 1–5 | Cite as

Complexity of non-iatrogenic ureteral injuries in children: single-center experience

  • Tamer E. Helmy
  • Osama M. SarhanEmail author
  • Ahmed M. Harraz
  • Mohamed Dawaba
Urology – Original Paper



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.

Materials and methods

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.


Pediatric Injury Ureter Urinoma 



Road traffic accident


Computerized tomography


Percutaneous nephrostomy




Ureteropelvic junction


Intravenous pyelography


  1. 1.
    Elliott SP, McAninch JW (2003) Ureteral injuries from external violence: the 25-year experience at San Francisco General Hospital. J Urol 170:1213–1216PubMedCrossRefGoogle Scholar
  2. 2.
    Tezval H, Tezval M, von Klot C et al (2007) Urinary tract injuries in patients with multiple trauma. World J Urol 25:177–184PubMedCrossRefGoogle Scholar
  3. 3.
    Kunkle DA, Kansas BT, Pathak A et al (2006) Delayed diagnosis of traumatic ureteral injuries. J Urol 176:2503–2507PubMedCrossRefGoogle Scholar
  4. 4.
    Elliott SP, McAninch JW (2006) Ureteral injuries: external and iatrogenic. Urol Clin N Am 33:55–66CrossRefGoogle Scholar
  5. 5.
    Best CD, Petrone P, Buscarini M et al (2005) Traumatic ureteral injuries: a single institution experience validating the American Association for the Surgery of Trauma-Organ Injury Scale grading scale. J Urol 173:1202–1205PubMedCrossRefGoogle Scholar
  6. 6.
    Mulligan JM, Cagiannos I, Collins JP et al (1998) Ureteropelvic junction disruption secondary to blunt trauma: excretory phase imaging (delayed films) should help prevent a missed diagnosis. J Urol 159:67–70PubMedCrossRefGoogle Scholar
  7. 7.
    Srinivasa RN, Akbar SA, Jafri SZ et al (2009) Genitourinary trauma: a pictorial essay. Emerg Radiol 16(1):21–33PubMedCrossRefGoogle Scholar
  8. 8.
    Pereira BM, Ogilvie MP, Gomez-Rodriguez JC et al (2010) A review of ureteral injuries after external trauma. Scand J Trauma Resusc Emerg Med 18:6–17PubMedCrossRefGoogle Scholar
  9. 9.
    Ghali AM, El Malik EM, Ibrahim AI et al (1999) Ureteral injuries: diagnosis, management, and outcome. J Trauma 46:150–158PubMedCrossRefGoogle Scholar
  10. 10.
    Sarhan OM, Helmy TE, Hafez AT et al (2009) Ureterocalyceal anastomosis in children: is it still indicated. J Pediatr Urol 5:78–81PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2010

Authors and Affiliations

  • Tamer E. Helmy
    • 1
  • Osama M. Sarhan
    • 1
    Email author
  • Ahmed M. Harraz
    • 1
  • Mohamed Dawaba
    • 1
  1. 1.Urology and Nephrology Center, Faculty of MedicineMansoura UniversityMansouraEgypt

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