Infectious Complications of Delayed Ureter Reconstruction following Traumatic Ureter Injury

Author(s):
Lucy Hart; Dustin Hanos; Sonya Williams; Madeline Roorbach; Zachary Grady; Ryan B. Fransman; Elliot Bishop; Randi N. Smith; Jonathan Nguyen; Jason Sciarretta

Background:

Traumatic ureter injuries (TUI) are infrequently encountered and difficult to manage. For TUI requiring open repair, management decisions regarding reconstruction timing often varies: some patients may undergo immediate or early ureter repair, while some may require urinary diversion followed by eventual repair later.

Hypothesis:

Our primary aim is to compare infectious complications for early vs. delayed TUI repair. We hypothesized that patients requiring delayed repairs experience higher rates of infectious complications.

Methods:

A retrospective review of all TUI in adult patients was conducted at a high volume Level I trauma center from October 2011-2023. Delayed ureter reconstruction was defined as those repaired >7 days after TUI.

Results:

A total of 106 ureter injuries were identified, 59 of which required operative repair. All were the result of penetrating injury. Forty-eight (81.4%) underwent early repair at a mean 1.4 days after TUI, while 11 (18.6%) had late repairs at a mean 223 days. Delayed repair was associated with higher rates of damage control laparotomy (63.6% vs. 29.2% p=0.31), although injury severity score, and admission vitals and labs were similar between the two groups.

Delayed TUI repair was associated with a higher risk of urinary tract infection (UTI) (90.9% vs. 33.3% p<0.001), recurrent UTI (54.5% vs. 2.1% p<0.001), and percutaneous nephrostomy tube (PCN) dislodgement (p<0.001). Delayed repair was also with loss of renal function requiring nephrectomy or indefinite PCN (36.4%vs. 6.3% p=0.005).

Conclusions:

Intraoperative instability often necessitates delayed TUI repair with initial damage-control ureteral management, followed by eventual reconstruction. Patients undergoing delayed repairs have higher rates of UTI and loss of renal function when compared to those repaired early. Ureter repair during index operation or early takeback may mitigate these complications.