Damage to the ureters

Closed (subcutaneous) damage to the ureters in isolated form are extremely rare; the reason they may be bruised in the fall, kick hoof, timber, etc.,
Open damage ureter happen at gunshot wounds to his or at operations on pelvic organs (mainly, gynecological), when there is injury to the pelvic Department of the ureter, and wound often remains undetected during the operation.
Gunshot wounds of the ureters are rare. This is due, on the one hand, subtlety and mobility of the ureter, and on the other, the fact that it is located close to major blood vessels and organs of the abdominal cavity, wound which quickly leads to death.
The main symptoms of injury ureters are hematuria and urine out of wound apertures.
Casual wound ureter is not seen during the operation, are depending on operational access to education, mochetocnika-vaginal fistula, peritonitis, or abscess of fiber.
Wounds in the upper segment of the ureter require differentiation from injury of the kidney, which does not present any particular difficulties and achieved through the urinary and retrograde pielografii.
Harder to distinguish injury to the pelvic segment of the ureter from the wounds of the bladder. Differential characteristics are: 1) normal urine when there is a injury of the ureter and disorder urination when wounded bubble; 2) the delay or absence of allocation of Indigo Carmine from the mouth of the wounded ureter; 3) the obstacle on the ground injured ureter when catheterization; 4) in the blue staining of urine is released from the fistula during the filling of the bladder solution metilenovogo blue in the event of his wounds and nekrasivaya urine when wounded ureter. Sometimes valuable services are provided by a fistulography.
Treatment. If the wound ureter during the operation immediately recognized, should immediately restore its integrity. In case of incomplete break the defect is sutured over ureteric catheter is introduced into the lumen of the ureter, the complete rupture - sew the ureter over the catheter end to end. If the wound ureter is discovered later, must immediately vnebrachnyi slit widely to drain fat and give outflow pouring in her urine. Under this condition, a partial rupture of the ureter heal without stitches.
When stubbornly persisting fistula ureter or circular breaks it used plastic surgery to restore the integrity of the ureter, if the kidney is kept functional ability. This includes the industry of the Central segment of the ureter in the peripheral or its implantation into the bladder. If the Central stump ureter is too short, the missing piece it may be replaced by a tube is formed from the flap of the bubble at the bottom (operation of Bari) or from off the hinges jejunum on the mesentery (putting plastic ureter).