ABSTRACT
Injury to the ureter is relatively rare. We retrospectively reviewed our experience with 21 cases of ureteric injury from penetrating trauma at the Lincoln Medical Center. Two injuries resulted from stab wounds and 19 from gunshot wounds. Total ureteric disruption occurred in 14 cases, partial transection in four and contusion in three. Preoperative screening was unreliable in accurately predicting the injury with hematuria being present in 66 per cent of cases. Similarly, intravenous urogram was diagnostic in 14 per cent and suspicious in another 42 per cent. Most injuries were diagnosed intraoperatively and exploration of the retro peritoneum remains the only definitive method of excluding ureteric injuries. Most patients were critically ill (mean ISS 27) due to associated injuries (90 per cent). Neither peritoneal contamination associated with hollow viscous injuries nor hypotension adversely affected the healing of ureteric anastomoses. Anastomotic leak developed in three (14 per cent) cases and one of them required operative correction. Another two patients developed infections related to the urinary tract.
Subject(s)
Ureter/injuries , Wounds, Penetrating/surgery , Abdominal Injuries/surgery , Adolescent , Adult , Female , Humans , Male , Multiple Trauma/surgery , Postoperative Complications , Retrospective Studies , Wounds, Gunshot/surgery , Wounds, Penetrating/diagnosisABSTRACT
We treated 101 patients at our stone facility with the Dornier HM3 lithotriptor modified with the anesthesia-free design upgrade. A protocol designed by our anesthesiologists consisting of intravenous and intramuscular injections for sedation was used without any general or regional anesthesia required. Pre-medication with intramuscular meperidine and promethazine, and oral diazepam was sufficient sedation in 43 patients, while 37 required additional intravenous meperidine and/or midazolam during the procedure, 16 were treated with intraprocedural medication alone and 5 required no medication at all. Care before, during and after the procedure was rendered by the urology staff for patients in American Society of Anesthesiologists risk category I or II. Treatment was successfully completed in all patients without complications. We compared this group to the 99 patients treated consecutively before the modification. Voltage used, number of shocks and stone burden were comparable in the 2 groups but average treatment time was prolonged with the upgraded equipment (39.2 versus 27.1 minutes) to a significant degree (p less than 0.001).
