Ureteral Trauma Due to Penetrating Missiles

Abstract

Ureteral injury secondary to penetrating weapons has been described as rare. Fisher et al. (1972), in reviewing the literature in 1971, found 123 ureteral injuries secondary to gunshot wounds, including only 33 reported during World War II. Culp (1947) reported an incidence of ureteral injury as 3.75% out of 160 urogenital injuries during World War II. Holden et al. (1976) reported 63 cases in 1976. Our series is composed of 59 cases of ureteral injury secondary to external violence over a 10-year period (Bright and Peters, 1977). The reasons for infrequent injury are: (1) the ureter is a small tubular organ surrounded by loose retroperitoneal fat and connective tissue which allows great mobility; (2) its depth in the retroperitoneal fossa makes it quite inaccessible to any except major injury; (3) it is protected by thick surrounding structures, e.g., the vertebral column medially, the psoas and paraspinal muscles posteriorly and laterally, and the peritoneum with its contents anteriorly. The course of the ureter is depicted in Fig. 1.