Traumatic ureteral injuries in children

Objective. To study the diagnosis and optimal treatment of ureteral injuries in children. Material and methods. There were 7 children with ureteral damage aged from 5 months to 16 years (4 girls and 3 boys). One girl had a gunshot injury. Other ones had surgical injury. Diagnostic measures included medical history collection, physical examination, blood and urine test, ECG, ultrasound of the urinary system, cystoscopy, ureteral catheterization. X-ray examination included X-ray imaging, excretory urography, cystography, CT and MRI of the abdominal cavity and pelvis. Results. Seven children with ureteral damage underwent surgery. Exploration of retroperitoneal space and abdominal cavity was performed in a girl with gunshot wound of the left ureter. Two catgut sutures were applied to the ureteral wound. Foreign bodies (pellets) 0.2×0.2 cm were removed. Drainage of paranephral space was necessary. In 6 children with surgical ureteral injury, ureters were transplanted using Polytan-Leadbetter procedure (in 2 children), ureteroureterostomy (in 2 children), appendico-uretero-cystostomy (in 1 child) and autologous kidney transplantation (in 1 child). All children demonstrated favorable results. Conclusion. Diagnosis of ureteral injuries in children is difficult and requires a thorough urological examination. Timely recognition of ureteral injuries in children allows for organ-preserving surgeries: ureteral wound suturing, ureteroureterostomy, appendico-uretero-cystostomy, autologous kidney transplantation.