p.1
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What is the primary cause of iatrogenic ureteral injury?
Iatrogenic ureteral injury primarily occurs during pelvic surgeries such as gynecologic, urologic, or colorectal surgery.
p.1
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What type of mechanism is most commonly associated with traumatic ureteral injuries?
Most traumatic ureteral injuries are due to a penetrating mechanism, predominantly in young males.
p.1
Clinical Presentation and Diagnosis of Ureteral Injury
How are ureteral injuries typically recognized?
Ureteral injuries may only be recognized early if they are specifically evaluated for based on clinical suspicion.
p.1
Treatment Options for Ureteral Injury
What are the treatment options for ureteral injuries?
Treatment may include placement of a ureteral stent or surgical repair, depending on the severity and location of the injury.
p.18
Surgical Techniques for Ureteral Repair
What is ureteroureterostomy?
Ureteroureterostomy is the surgical procedure that involves the anastomosis of the spatulated ends of the proximal and distal portions of the ureter using interrupted, absorbable sutures.
p.3
Clinical Presentation and Diagnosis of Ureteral Injury
What is the incidence of iatrogenic injury for laparoscopic colectomy compared to open surgery?
0.53 percent for laparoscopic colectomy compared to 0.66 percent for open surgery.
p.8
Overview of Ureteral Injury
What percentage of ureteral injury cases require repair according to one study?
97 percent of cases require repair.
p.16
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What is the description of a Grade V ureter injury?
Avulsion with >2 cm of devascularization.
p.7
Surgical Techniques for Ureteral Repair
What is the recommended approach for iatrogenic urinary tract injury recognized during surgery?
It should be repaired intraoperatively when identified rather than delaying for a subsequent surgery, if possible.
p.2
Overview of Ureteral Injury
What structures protect the ureters within the retroperitoneum?
The ureters are protected by visceral organs, the psoas muscles, vertebrae, and pelvic bones.
p.20
Surgical Techniques for Ureteral Repair
What is the Boari flap technique used for?
The Boari flap technique is used to repair extensively damaged middle third ureters.
p.23
Clinical Presentation and Diagnosis of Ureteral Injury
What does the delayed phase of a CT scan reveal in cases of grade IV renal trauma?
It shows a grade IV blunt renal trauma involving the left kidney with progression to a urinoma.
p.8
Surgical Techniques for Ureteral Repair
What is recommended for managing ureteral injuries caused by penetrating gunshot injuries?
Adequate debridement and reconstruction at the time of laparotomy, depending on the extent of tissue involvement.
p.9
Treatment Options for Ureteral Injury
What is recommended for acute management of severe collecting system injuries?
Ureteral stent and bladder catheter or nephrostomy tube placement is recommended for acute management with delayed ureteral reconstruction three to six months later.
p.21
Surgical Techniques for Ureteral Repair
When is the procedure of autotransplanting a kidney into the iliac fossa performed?
This procedure is not performed when other options are available to repair the proximal ureter.
p.11
Clinical Presentation and Diagnosis of Ureteral Injury
What is the most sensitive method to assess for ureteral injury in trauma patients?
Direct inspection of the ureters in the operating room.
p.19
Surgical Techniques for Ureteral Repair
What is the final outcome of Psoas hitch ureteral reimplantation?
The final outcome includes the reimplanted ureter, anchored bladder, and the closed cystostomy.
p.23
Complications Associated with Ureteral Injury
What is a urinoma?
A urinoma is a collection of urine outside the urinary tract, often resulting from renal trauma.
p.3
Prevention Strategies for Iatrogenic Ureteral Injury
What is the purpose of placing prophylactic ureteral stents before surgery?
To assist with intraoperative identification of the ureter.
p.16
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What is the guideline for grading bilateral ureter injuries?
Advance one grade for bilateral up to grade III.
p.4
Clinical Presentation and Diagnosis of Ureteral Injury
What symptoms may indicate a missed ureteral injury?
Symptoms may include vague malaise, abdominal/flank pain, nausea/vomiting, fever, and delayed passage of stool/flatus, along with signs of a urine leak.
p.9
Surgical Techniques for Ureteral Repair
When can ureteral reconstruction be performed after stabilization?
Ureteral reconstruction can be performed within a timeframe of five to seven days after the patient has stabilized.
p.9
Imaging Techniques for Ureteral Injury Diagnosis
What preoperative imaging can aid surgical planning for delayed reconstruction?
Preoperative antegrade nephrostogram with or without combined retrograde pyelogram can aid surgical planning.
p.14
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What type of injuries does Azimuddin et al. focus on in their study?
The study focuses on penetrating ureteric injuries.
p.12
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What unusual case is discussed in the article by Fomekong et al.?
The article discusses a case of ureteral perforation during minimally invasive pedicle screw instrumentation.
p.12
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What does the study by Bašić et al. analyze regarding iatrogenic ureteral trauma?
It analyzes a 16-year experience at a single tertiary center.
p.22
Surgical Techniques for Ureteral Repair
How is the ileal ureter constructed?
A segment of ileum is isolated from the intestinal tract and sutured to the ureter proximally and to the bladder distally.
p.23
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What type of trauma is indicated in the CT scan for the left kidney?
Grade IV blunt renal trauma.
p.11
Clinical Presentation and Diagnosis of Ureteral Injury
What can be used to aid the assessment of ureteral injury during direct inspection?
Intravenous dyes such as methylene blue or indigo carmine.
p.7
Imaging Techniques for Ureteral Injury Diagnosis
What imaging technique should be attempted for delayed ureteral injury presentation?
Retrograde imaging with ureteral stent placement should be attempted initially.
p.8
Surgical Techniques for Ureteral Repair
What surgical options are available for ureteral injury repair?
Primary reapproximation, spatulated ureteroureterostomy, and ureteral reimplantation.
p.9
Treatment Options for Ureteral Injury
What is the recommended management for complex ureteral injuries?
Autotransplant or ileal ureter interposition is reserved for definitive management of complex ureteral injuries and should not be performed in the acute setting.
p.7
Treatment Options for Ureteral Injury
What is the management for iatrogenic injuries during endoscopic procedures?
They can initially be managed with a ureteral stent; if that fails, a percutaneous nephrostomy tube should be placed.
p.6
Imaging Techniques for Ureteral Injury Diagnosis
What imaging technique is used to reduce radiation exposure during repeat CT imaging for suspected ureteral injury?
A low-dose 'CT urinoma' study, which omits the parenchymal phase and includes a low-dose noncontrast phase followed by a delayed image phase 10 minutes after intravenous contrast administration.
p.10
Clinical Presentation and Diagnosis of Ureteral Injury
What are common symptoms of perinephric urinoma?
Most patients will present with fever, chills, and/or flank pain 7 to 10 days after acute injury.
p.6
Treatment Options for Ureteral Injury
What is the general treatment approach for ureteral injuries?
Ureteral injuries generally require treatment using either minimally invasive or open reconstructive techniques.
p.10
Overview of Ureteral Injury
Is ureteral injury common or rare?
Ureteral injury is very rare compared to other genitourinary organs.
p.10
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What type of trauma is most often associated with traumatic ureteral injuries?
Most traumatic ureteral injuries are due to penetrating trauma, with younger males predominantly affected.
p.5
Clinical Presentation and Diagnosis of Ureteral Injury
What imaging technique is typically used to diagnose ureteral injury?
Contrast-enhanced computed tomography (CT) scan of the abdomen/pelvis with delayed ureter imaging.
p.14
Treatment Options for Ureteral Injury
What is the main topic of Ku et al.'s research?
The research discusses minimally invasive management of ureteral injuries recognized late after obstetric and gynecologic surgery.
p.22
Surgical Techniques for Ureteral Repair
What is ileal ureter interposition used for?
Ileal ureter reconstruction is used for a long-segment ureteral injury/stricture when other reconstructions are not options.
p.21
Surgical Techniques for Ureteral Repair
What is represented by the figure of an autotransplanted kidney in the iliac fossa?
An autotransplanted kidney into the iliac fossa secondary to an extensively traumatized proximal ureter.
p.19
Surgical Techniques for Ureteral Repair
What does Psoas hitch ureteral reimplantation involve?
It involves mobilization of the bladder, anchoring it to the psoas muscle with nonabsorbable sutures, and reimplanting the ureter into the dome of the bladder.
p.19
Surgical Techniques for Ureteral Repair
Where is the cystostomy performed in Psoas hitch ureteral reimplantation?
The cystostomy is performed away from the dome of the bladder.
p.3
Treatment Options for Ureteral Injury
What is associated with the least morbidity in the treatment of ureteral injuries?
Treatment of ureteral injuries at the time of injury.
p.16
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What is the description of a Grade I ureter injury?
Contusion or hematoma without devascularization.
p.8
Surgical Techniques for Ureteral Repair
What is the preferred approach when tissue viability is questionable in ureteral injury?
Excision and ureteral reconstruction are strongly preferred.
p.8
Imaging Techniques for Ureteral Injury Diagnosis
What imaging techniques can be used to assess ureteral healing after stent placement?
A contrast-enhanced CT scan with delayed images or a retrograde pyelogram can be performed.
p.11
Treatment Options for Ureteral Injury
What may be necessary for severe ureteral injuries?
Ligation of the ureter with urinary drainage and delayed reconstruction.
p.16
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What defines a Grade IV ureter injury?
Complete transection with <2 cm devascularization.
p.7
Treatment Options for Ureteral Injury
What should be done if ureteral stent placement is unsuccessful?
Percutaneous nephrostomy should be performed.
p.4
Clinical Presentation and Diagnosis of Ureteral Injury
What is the significance of clinical suspicion in patients with blunt or penetrating trauma regarding ureteral injury?
Clinical suspicion should be guided by the mechanism of injury, with a history of rapid deceleration, multisystem abdominal trauma, or penetrating trauma increasing the suspicion for ureteral injury.
p.7
Treatment Options for Ureteral Injury
How should complicated ureteral injuries with abscess or urinoma formation be managed initially?
Initial percutaneous nephrostomy with periureteral drainage is preferred with plans for delayed ureteral reconstruction.
p.1
Overview of Ureteral Injury
What is the relationship between traumatic ureteral injuries and other severe injuries?
Traumatic ureteral injuries are frequently associated with other severe injuries.
p.7
Treatment Options for Ureteral Injury
What is the initial management for ureteral injury if reconstruction cannot be undertaken?
Temporary urinary drainage is used to control urine until definitive repair/reconstruction can be undertaken.
p.3
Prevention Strategies for Iatrogenic Ureteral Injury
What should a surgeon document when performing a procedure near the ureters?
The surgeon should document that the ureters were identified and protected or provide a reason if this was not possible.
p.4
Clinical Presentation and Diagnosis of Ureteral Injury
Why is the absence of hematuria not a reliable indicator for excluding ureteral injury?
Hematuria is present in less than one half of patients with a ureteric injury, making it an unreliable finding following ureteral trauma.
p.8
Surgical Techniques for Ureteral Repair
What is the recommended treatment for distal ureteral injuries?
Ureteral reimplantation of the proximal injured ureter to the bladder is recommended.
p.9
Imaging Techniques for Ureteral Injury Diagnosis
What imaging technique is helpful to assess patency of the reconstructed ureter?
Radionuclide scintigraphy (MAG3 renogram with furosemide) at 3 and 12 months following ureteral repair is helpful.
p.15
Complications Associated with Ureteral Injury
What complication is associated with ureteroscopic perforation according to Kriegmair and Schmeller?
Paraureteral calculi are caused by ureteroscopic perforation.
p.12
Overview of Ureteral Injury
What is the focus of the review by Pereira et al. on ureteral injuries?
The review focuses on ureteral injuries after external trauma.
p.15
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What type of injuries are discussed by Brandes et al. in their study?
They discuss ureteral injuries from penetrating trauma.
p.15
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What specific type of injury does Rober et al. focus on in their research?
They focus on gunshot injuries of the ureter.
p.2
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What is the most common type of traumatic ureteral injury?
Penetrating trauma is the most common, accounting for 60 to 77 percent of cases.
p.15
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What is the subject of the study by Rencken et al. regarding the ureter?
They study trauma of the ureter.
What percentage of patients with traumatic ureteral injury have associated injuries?
Associated injuries were present in 91 percent of patients with traumatic ureteral injury.
p.5
Clinical Presentation and Diagnosis of Ureteral Injury
What intravenous dyes can be used to assess for dye leakage along the ureter?
Methylene blue and indigo carmine.
p.12
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What types of ureteral injuries are discussed by Elliott and McAninch?
They discuss external and iatrogenic ureteral injuries.
p.13
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What type of trauma is discussed by Carver BS et al. in relation to ureteral injury?
Ureteral injury due to penetrating trauma.
p.13
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What type of injuries does Abid AF and Hashem HL discuss?
Ureteral injuries from gunshots and shells of explosive devices.
p.8
Surgical Techniques for Ureteral Repair
How should proximal and midureteral injuries be treated?
Using primary closure or spatulated ureteroureterostomy.
p.7
Surgical Techniques for Ureteral Repair
What is the management for complete ureteral transections?
A perinephric tube can be placed and formal repair performed within the first seven days after injury, or delayed three months later depending on the patient's clinical status.
p.14
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What is the focus of the study by Akay et al. regarding gunshot injuries?
The study presents a 15-year experience at one center dealing with gunshot injuries of the ureter.
p.10
Imaging Techniques for Ureteral Injury Diagnosis
What imaging technique is used to diagnose perinephric urinoma?
Contrast-enhanced computed tomography (CT) scan with delayed images provides the diagnosis.
p.14
Surgical Techniques for Ureteral Repair
What is the main topic of the article by Zinman and Vanni?
The article discusses the surgical management of urologic trauma and iatrogenic injuries.
p.12
Incidence of Ureteral Injury
What is the main finding of Marcelissen et al.'s study on iatrogenic ureteral injury?
The study examines the incidence of iatrogenic ureteral injury during open and laparoscopic colorectal surgery.
p.14
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What type of injuries are discussed by Giberti et al.?
They discuss obstetric and gynecological ureteric injuries, including treatment and results.
p.5
Clinical Presentation and Diagnosis of Ureteral Injury
What can aid the evaluation if a ureteral injury is suspected but not proven by CT scan?
Cystoscopy with retrograde pyelography.
p.14
Complications Associated with Ureteral Injury
What trend does Lask et al. examine in their study?
They examine changing trends in the management of iatrogenic ureteral injuries.
p.13
Imaging Techniques for Ureteral Injury Diagnosis
What does Gross JA et al. cover in their article?
Imaging of urinary system trauma.
p.13
Imaging Techniques for Ureteral Injury Diagnosis
What aspect of urinary tract complications does Patel BN and Gayer G focus on?
Imaging of iatrogenic complications of the urinary tract, including kidneys, ureters, and bladder.
p.4
Clinical Presentation and Diagnosis of Ureteral Injury
What percentage of ureteral injuries were initially missed according to one review?
38 percent of ureteral injuries were initially missed.
p.10
Complications Associated with Ureteral Injury
What can develop following a collecting system or ureteral injury that does not heal?
Perinephric urinoma can develop following a collecting system or ureteral injury that does not heal.
p.14
Clinical Presentation and Diagnosis of Ureteral Injury
What does the study by Best et al. validate?
It validates the American Association for the Surgery of Trauma-Organ Injury Scale grading scale for traumatic ureteral injuries.
p.10
Treatment Options for Ureteral Injury
What is the treatment for perinephric urinoma?
Treatment involves placement of a perinephric drain and appropriate antimicrobial therapy.
p.2
Overview of Ureteral Injury
What are the primary functions of the ureters?
The ureters are tubular structures that convey urine from the renal pelvis to the bladder.
p.14
Clinical Presentation and Diagnosis of Ureteral Injury
What was the focus of Hamano et al.'s study?
The study focused on ureteral stone management using semirigid ureteroscopes in 1,082 patients.
How is the diagnosis of ureteral injury typically made in hemodynamically stable patients?
The diagnosis of ureteral injury is typically made using contrast-enhanced computed tomography (CT) scan of the abdomen/pelvis.
p.14
Overview of Ureteral Injury
What does Cormio's study focus on?
It focuses on clinical and experimental studies of ureteric injuries.
p.13
Imaging Techniques for Ureteral Injury Diagnosis
What was the main finding of Haste AK et al. regarding abdominopelvic CT?
The diagnostic yield and clinical utility of abdominopelvic CT following emergent laparotomy for trauma.
p.12
Prevention Strategies for Iatrogenic Ureteral Injury
What does Bothwell et al.'s review focus on?
The review focuses on prophylactic ureteral catheterization in colon surgery over five years.
p.12
Overview of Ureteral Injury
What does Elliott and McAninch's 25-year experience study focus on?
It focuses on ureteral injuries from external violence at San Francisco General Hospital.
p.9
Treatment Options for Ureteral Injury
What should be done for ureteral injury in hemodynamically unstable patients?
The ureter can be ligated to prevent urine extravasation, with subsequent options for urinary drainage including placement of a nephrostomy tube.
p.15
Overview of Ureteral Injury
What is the focus of the audit conducted by Butler et al. on ureteroscopies?
The audit focuses on intra-operative complications to justify proactive management of ureteric calculi.
p.6
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What factors do most surgeons consider when distinguishing ureteral injuries?
Surgeons distinguish ureteral injuries based on location (upper, mid, lower), mechanism of injury (blunt versus penetrating), and severity (complete versus partial transection).
p.15
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What type of trauma does Palmer et al. report on in their 10-year experience?
They report on penetrating ureteral trauma at an urban trauma center.
p.14
Treatment Options for Ureteral Injury
What approach does Koukouras et al. discuss for managing iatrogenic ureteral injuries?
They discuss percutaneous minimally invasive management.
p.10
Clinical Presentation and Diagnosis of Ureteral Injury
What should clinicians assess for when new symptoms occur after trauma stabilization?
Clinicians should assess for a potential ureteral injury when new symptoms of fever, flank pain, sepsis, and/or ileus occur.
p.2
Types of Ureteral Injury: Traumatic vs. Iatrogenic
Which demographic is most affected by traumatic ureteral injuries?
Younger males predominate in cases of traumatic ureteral injuries.
p.12
Clinical Presentation and Diagnosis of Ureteral Injury
What trends does Halabi et al. analyze in their study on ureteral injuries?
They analyze trends, outcomes, and risk factors of ureteral injuries in colorectal surgery over a 10-year period.
What types of injuries are commonly associated with penetrating ureteral injuries?
Bowel and vascular injuries are commonly associated with penetrating ureteral injuries.
p.5
Imaging Techniques for Ureteral Injury Diagnosis
What is suggested for hemodynamically stable patients with suspected ureteral injuries?
Using contrast-enhanced abdominal/pelvic CT with delayed imaging (CT urography).
p.5
Imaging Techniques for Ureteral Injury Diagnosis
How long should one wait after administering IV contrast to identify ureteral injuries?
A delay of 10 minutes is required.
p.4
Clinical Presentation and Diagnosis of Ureteral Injury
Where are the majority of missed ureteral injuries located?
The majority of missed injuries were located in the proximal ureters, which are less accessible, especially in the presence of retroperitoneal hematoma.
p.6
Overview of Ureteral Injury
How does the AAST grading system for ureteral injury primarily make a diagnosis?
The AAST grading system relies on visual inspection of the injury, as injury grades are difficult to assess using imaging alone.
p.15
Surgical Techniques for Ureteral Repair
What do Png and Chapple discuss in their work regarding ureteric reconstruction?
They discuss the principles of ureteric reconstruction.
p.6
Treatment Options for Ureteral Injury
What should be done for patients with worsening urinary extravasation on repeat imaging during conservative management?
They should be treated with the placement of a ureteral stent and urethral catheter to reduce pressure and promote healing.
p.6
Clinical Presentation and Diagnosis of Ureteral Injury
What is a common scenario in which traumatic ureteral injuries occur?
Most traumatic ureteral injuries occur in the setting of concomitant injuries that often require exploratory laparotomy.
p.12
Clinical Presentation and Diagnosis of Ureteral Injury
What does Palaniappa et al. investigate regarding laparoscopic colectomy?
They investigate the incidence of iatrogenic ureteral injury after laparoscopic colectomy.
p.13
Imaging Techniques for Ureteral Injury Diagnosis
What does the study by Baghdanian AA et al. discuss regarding diagnostic CT?
The use of diagnostic CT after life-saving laparotomy in damage control surgery.
p.12
Clinical Presentation and Diagnosis of Ureteral Injury
What question does Jha raise regarding ureteric injury?
Jha questions whether ureteric injury always leads to a guilty verdict.
p.14
Surgical Techniques for Ureteral Repair
What type of injuries does Liatsikos et al. address in their study?
They address ureteral injuries during gynecologic surgery and treatment with a minimally invasive approach.
p.12
Clinical Presentation and Diagnosis of Ureteral Injury
What issue is highlighted by Kunkle et al. regarding traumatic ureteral injuries?
They highlight the problem of delayed diagnosis of traumatic ureteral injuries.
p.13
Clinical Presentation and Diagnosis of Ureteral Injury
What are the main topics covered by Ghali AM et al. regarding ureteric injuries?
Diagnosis, management, and outcome of ureteric injuries.
p.14
Surgical Techniques for Ureteral Repair
What surgical technique is explored by De Cicco et al. in their research?
They explore laparoscopic management of ureteral lesions in gynecology.
p.13
Imaging Techniques for Ureteral Injury Diagnosis
What is the focus of the study by Miller KS and McAninch JW published in 1995?
Radiographic assessment of renal trauma over a 15-year experience.
p.12
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What comparison is made in Zafar et al.'s study?
The study compares ureteral injury rates after laparoscopic versus open colectomy.
p.2
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What can lead to iatrogenic ureteral injuries?
Iatrogenic ureteral injuries can occur during various abdominopelvic and retroperitoneal surgical procedures, as well as during endoscopic manipulation.
p.5
Clinical Presentation and Diagnosis of Ureteral Injury
What findings suggest ureteral injury during imaging?
Nonvisualization of the ureter, contrast extravasation from the ureter, ipsilateral hydronephrosis, and poor renal excretion.
p.13
Imaging Techniques for Ureteral Injury Diagnosis
What CT appearance is associated with urinomas caused by ureteral injuries according to Gayer G et al.?
CT appearance of urinomas caused by ureteral injuries.
p.12
Clinical Presentation and Diagnosis of Ureteral Injury
What factors are explored in Al-Awadi et al.'s research on iatrogenic ureteric injuries?
The research explores incidence, aetiological factors, and the effect of early management on outcomes.
p.2
Mechanisms of Ureteral Injury
What can cause avulsion of the ureter?
Deceleration can result in avulsion of the ureter at the ureteropelvic junction or distally along the ureter.
p.5
Clinical Presentation and Diagnosis of Ureteral Injury
What is the most sensitive method to assess for ureteral injury during exploration?
Direct inspection of the ureters.
p.14
Treatment Options for Ureteral Injury
What does Ustunsoz et al. focus on in their research?
They focus on percutaneous management of ureteral injuries diagnosed late after cesarean section.
p.14
Clinical Presentation and Diagnosis of Ureteral Injury
What is the focus of Al-Ghazo et al.'s retrospective study?
The study focuses on emergency ureteroscopic lithotripsy in acute renal colic caused by ureteral calculi.
p.13
Imaging Techniques for Ureteral Injury Diagnosis
What is the optimal timing discussed by Keihani S et al. for a delayed excretory phase CT scan?
For diagnosis of urinary extravasation after high-grade renal trauma.
p.13
Imaging Techniques for Ureteral Injury Diagnosis
What challenge is highlighted by Alabousi A et al. regarding ureteral injuries?
The difficulty in detecting traumatic and iatrogenic ureteral injuries.
p.5
Imaging Techniques for Ureteral Injury Diagnosis
What is a potential risk associated with using CT for diagnosing ureteral injuries?
Contrast-related complications, radiation exposure, and the dangers of transporting a trauma patient.
p.13
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What is the focus of Fraga GP et al.'s study?
Penetrating ureteral trauma.
p.4
Clinical Presentation and Diagnosis of Ureteral Injury
What is a key factor in increasing suspicion for ureteral injury in trauma patients?
A) History of rapid deceleration
B) Presence of hematuria
C) Age of the patient
D) Previous kidney stones
E) Duration of hospital stay
A) History of rapid deceleration
Explanation: A history of rapid deceleration, along with multisystem abdominal trauma, is crucial in guiding the level of suspicion for ureteral injury in patients with blunt or penetrating trauma.
p.15
Surgical Techniques for Ureteral Repair
What do Png and Chapple discuss in their work regarding ureteric reconstruction?
A) Surgical instruments
B) Principles of ureteric reconstruction
C) Patient demographics
D) Recovery times
E) Cost analysis
B) Principles of ureteric reconstruction
Explanation: Png and Chapple focus on the principles of ureteric reconstruction, which is crucial for understanding the surgical management of ureteral injuries.
p.1
Types of Ureteral Injury: Traumatic vs. Iatrogenic
In which demographic are traumatic ureteral injuries most frequently observed?
A) Elderly females
B) Young males
C) Children
D) Middle-aged females
E) Infants
B) Young males
Explanation: Traumatic ureteral injuries predominantly occur in young males, often due to penetrating mechanisms, highlighting a specific demographic at risk.
p.13
Imaging Techniques for Ureteral Injury Diagnosis
What is the focus of the research conducted by Keihani S et al. in 2019?
A) Timing of CT scans for urinary extravasation diagnosis
B) Management of renal trauma
C) Long-term outcomes of ureteral injuries
D) Non-invasive imaging techniques
E) Surgical interventions for kidney injuries
A) Timing of CT scans for urinary extravasation diagnosis
Explanation: The research investigates the optimal timing for delayed excretory phase CT scans to diagnose urinary extravasation following high-grade renal trauma.
p.4
Clinical Presentation and Diagnosis of Ureteral Injury
What symptom may indicate a missed ureteral injury?
A) Increased appetite
B) Urinary ascites
C) Weight gain
D) Skin rash
E) Joint pain
B) Urinary ascites
Explanation: Symptoms such as urinary ascites, along with others like vague malaise and abdominal pain, may indicate a missed ureteral injury, especially if they arise after initial trauma.
p.8
Surgical Techniques for Ureteral Repair
What percentage of ureteral injury cases require repair according to one study?
A) 50 percent
B) 75 percent
C) 90 percent
D) 97 percent
E) 100 percent
D) 97 percent
Explanation: Ureteral injury is highly associated with the need for repair, with 97 percent of cases requiring surgical intervention as indicated in the study.
p.23
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What type of renal trauma is indicated in the CT scan?
A) Grade I renal trauma
B) Grade II renal trauma
C) Grade III renal trauma
D) Grade IV renal trauma
E) Grade V renal trauma
D) Grade IV renal trauma
Explanation: The CT scan specifically shows a grade IV blunt renal trauma involving the left kidney, indicating a severe level of injury.
p.21
Surgical Techniques for Ureteral Repair
When is an autotransplanted kidney procedure typically not performed?
A) When the kidney is healthy
B) When other options are available to repair the proximal ureter
C) When the patient is elderly
D) When there is a risk of infection
E) When the kidney is small
B) When other options are available to repair the proximal ureter
Explanation: The procedure of autotransplanting a kidney is not performed if there are other viable options available to repair the proximal ureter, indicating that it is a last resort in surgical management.
p.13
Complications Associated with Ureteral Injury
What challenge is addressed in the study by Alabousi A et al. regarding ureteral injuries?
A) Detection of traumatic and iatrogenic ureteral injuries
B) Surgical techniques for ureteral repair
C) Long-term management of ureteral injuries
D) Prevention strategies for urinary tract injuries
E) Imaging techniques for kidney assessment
A) Detection of traumatic and iatrogenic ureteral injuries
Explanation: The study discusses the challenges in detecting traumatic and iatrogenic ureteral injuries, emphasizing the need for multi-modality imaging.
p.15
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What type of trauma is addressed in the study by Palmer et al.?
A) Blunt trauma
B) Penetrating ureteral trauma
C) Chemical burns
D) Thermal injuries
E) Sports injuries
B) Penetrating ureteral trauma
Explanation: Palmer et al. specifically examine penetrating ureteral trauma in their 10-year experience at an urban trauma center, providing insights into this type of injury.
p.4
Clinical Presentation and Diagnosis of Ureteral Injury
Why is hematuria considered an unreliable finding in ureteral trauma?
A) It is always present
B) It is present in less than half of patients
C) It only occurs in older patients
D) It is only seen in renal injuries
E) It is a common symptom of dehydration
B) It is present in less than half of patients
Explanation: Hematuria is considered unreliable in the context of ureteral trauma because it is present in less than half of patients with ureteric injuries, making it a poor indicator for diagnosis.
p.18
Surgical Techniques for Ureteral Repair
What is depicted in the figure related to ureteroureterostomy?
A) A kidney transplant
B) The bladder anatomy
C) The anastomosis of ureter ends
D) A ureteral stent placement
E) A nephrectomy procedure
C) The anastomosis of ureter ends
Explanation: The figure illustrates the anastomosis of the spatulated ends of the proximal and distal portions of the ureter, which is central to the ureteroureterostomy procedure.
p.13
Clinical Presentation and Diagnosis of Ureteral Injury
What was the main topic of the 2016 study by Baghdanian AA et al.?
A) Use of MRI in renal trauma
B) Damage control surgery and diagnostic CT after laparotomy
C) Long-term outcomes of renal surgery
D) Non-invasive techniques for kidney assessment
E) Pediatric renal trauma management
B) Damage control surgery and diagnostic CT after laparotomy
Explanation: The study discusses the use of diagnostic CT following life-saving laparotomy in the context of damage control surgery, highlighting its importance in trauma care.
p.4
Clinical Presentation and Diagnosis of Ureteral Injury
What percentage of ureteral injuries were initially missed according to one review?
A) 10%
B) 25%
C) 38%
D) 50%
E) 75%
C) 38%
Explanation: One review noted that 38 percent of ureteral injuries were initially missed, highlighting the challenges in diagnosing these injuries.
p.7
Treatment Options for Ureteral Injury
What is the initial management for ureteral injury if reconstruction cannot be undertaken?
A) Immediate surgery
B) Temporary urinary drainage
C) Observation only
D) Antibiotic therapy
E) Pain management
B) Temporary urinary drainage
Explanation: If reconstruction cannot be performed, temporary urinary drainage is utilized to control urine until definitive repair or reconstruction can be undertaken, ensuring patient safety and managing the injury effectively.
p.9
Surgical Techniques for Ureteral Repair
When should ureteral reconstruction be performed after an injury?
A) Immediately after injury
B) Within 24 hours
C) Within five to seven days after stabilization
D) After one month
E) Only if the patient is stable for three months
C) Within five to seven days after stabilization
Explanation: Ureteral reconstruction can be performed once the patient has stabilized, ideally within a timeframe of five to seven days, to ensure better outcomes.
p.6
Clinical Presentation and Diagnosis of Ureteral Injury
What does the AAST grading system for ureteral injury primarily rely on?
A) Blood tests
B) Visual inspection of the injury
C) Patient symptoms
D) Imaging results
E) Surgical history
B) Visual inspection of the injury
Explanation: The AAST grading system for ureteral injury is based on visual inspection, as imaging alone is often insufficient for accurately assessing injury grades.
p.6
Types of Ureteral Injury: Traumatic vs. Iatrogenic
How do most surgeons distinguish ureteral injuries?
A) By the patient's age
B) By the location, mechanism, and severity of injury
C) By the type of imaging used
D) By the patient's medical history
E) By the duration of symptoms
B) By the location, mechanism, and severity of injury
Explanation: Most surgeons categorize ureteral injuries based on their location (upper, mid, lower), mechanism (blunt vs. penetrating), and severity (complete vs. partial transection), which helps guide surgical management.
p.3
Prevention Strategies for Iatrogenic Ureteral Injury
What is a recommended preventive measure during surgeries near the ureters?
A) Avoiding the use of anesthesia
B) Placing prophylactic ureteral stents
C) Performing open surgery only
D) Using larger surgical instruments
E) Reducing the number of surgical staff
B) Placing prophylactic ureteral stents
Explanation: Placing prophylactic ureteral stents prior to surgery is recommended to assist with intraoperative identification of the ureter, especially in scarred operative fields, although the effectiveness of stents in preventing injury is debated.
p.12
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What is the primary focus of the article by Pereira et al. (2010)?
A) Iatrogenic ureteral injuries
B) Ureteral injuries after external trauma
C) Ureteral injuries in laparoscopic surgery
D) Incidence of ureteral injuries in children
E) Surgical techniques for ureteral repair
B) Ureteral injuries after external trauma
Explanation: The article by Pereira et al. reviews ureteral injuries specifically resulting from external trauma, highlighting the mechanisms and implications of such injuries.
p.12
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What was the focus of Bašić et al.'s (2015) study?
A) Incidence of ureteral injuries in sports
B) Iatrogenic ureteral trauma over 16 years
C) Ureteral injuries in emergency situations
D) Surgical techniques for ureteral repair
E) Prevention of ureteral injuries
B) Iatrogenic ureteral trauma over 16 years
Explanation: Bašić et al. conducted a study analyzing iatrogenic ureteral trauma over a 16-year period at a single tertiary center, providing insights into the incidence and management of such injuries.
p.2
Mechanisms of Ureteral Injury
What type of trauma is most common in ureteral injuries?
A) Blunt trauma
B) Penetrating trauma
C) Thermal trauma
D) Chemical trauma
E) Electrical trauma
B) Penetrating trauma
Explanation: Penetrating trauma is the most common type of injury to the ureters, accounting for 60 to 77 percent of cases, with gunshot wounds being a significant contributor.
p.12
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What aspect of iatrogenic ureteric injuries did Al-Awadi et al. (2005) examine?
A) Surgical techniques for repair
B) Incidence and aetiological factors
C) Ureteral injuries in trauma patients
D) Long-term management of ureteral injuries
E) Prevention strategies for ureteral injuries
B) Incidence and aetiological factors
Explanation: Al-Awadi et al. studied the incidence of iatrogenic ureteric injuries, the factors contributing to them, and the effect of early management on outcomes, providing valuable data for clinical practice.
p.20
Surgical Techniques for Ureteral Repair
What is the primary purpose of the Boari flap technique?
A) To enhance kidney function
B) To repair extensively damaged middle third ureters
C) To treat urinary tract infections
D) To remove kidney stones
E) To perform a kidney transplant
B) To repair extensively damaged middle third ureters
Explanation: The Boari flap technique is specifically designed for the repair of extensively damaged middle third ureters, making it a crucial surgical method in urology.
p.21
Surgical Techniques for Ureteral Repair
What is the primary reason for performing an autotransplantation of the kidney into the iliac fossa?
A) To enhance kidney function
B) Due to an extensively traumatized proximal ureter
C) To increase kidney size
D) To prevent kidney stones
E) To improve blood flow to the kidney
B) Due to an extensively traumatized proximal ureter
Explanation: The autotransplantation of the kidney into the iliac fossa is specifically indicated when there is extensive trauma to the proximal ureter, making it necessary to relocate the kidney to preserve its function.
p.15
Complications Associated with Ureteral Injury
What complication is associated with ureteroscopic perforation according to Kriegmair and Schmeller?
A) Hemorrhage
B) Paraureteral calculi
C) Infection
D) Urinary incontinence
E) Renal failure
B) Paraureteral calculi
Explanation: Kriegmair and Schmeller discuss paraureteral calculi as a complication resulting from ureteroscopic perforation, highlighting the potential risks involved in the procedure.
p.23
Clinical Presentation and Diagnosis of Ureteral Injury
What does the arrow labeled 'A' in the CT scan indicate?
A) Normal kidney
B) Grade IV renal trauma
C) Urinoma
D) Renal artery
E) Renal vein
B) Grade IV renal trauma
Explanation: The arrow labeled 'A' in the CT scan points to the area of the left kidney that is affected by the grade IV renal trauma.
p.18
Surgical Techniques for Ureteral Repair
What type of suture is used in ureteroureterostomy?
A) Non-absorbable suture
B) Interrupted, absorbable suture
C) Continuous, non-absorbable suture
D) Silk suture
E) Nylon suture
B) Interrupted, absorbable suture
Explanation: The procedure involves the use of interrupted, absorbable sutures for the anastomosis of the ureter, which allows for healing without the need for suture removal.
p.5
Clinical Presentation and Diagnosis of Ureteral Injury
What is the most sensitive method to assess for ureteral injury?
A) CT scan
B) Cystoscopy
C) Direct inspection of the ureters
D) MRI
E) Ultrasound
C) Direct inspection of the ureters
Explanation: Direct inspection of the ureters during surgical exploration is considered the most sensitive method to assess for ureteral injury, allowing for immediate identification of any damage.
p.14
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What is the focus of the study by Akay et al. published in Acta Chir Belg in 2006?
A) Management of kidney stones
B) Gunshot injuries of the ureter
C) Laparoscopic surgery techniques
D) Ureteral injuries during pregnancy
E) Ureteral cancer treatment
B) Gunshot injuries of the ureter
Explanation: The study by Akay et al. specifically addresses gunshot injuries of the ureter, detailing a 15-year experience at a single center, which highlights the clinical aspects of such traumatic injuries.
p.14
Clinical Presentation and Diagnosis of Ureteral Injury
What grading scale is validated in the study by Best et al. in the Journal of Urology?
A) American Urological Association Scale
B) American Association for the Surgery of Trauma-Organ Injury Scale
C) European Urology Association Scale
D) National Institutes of Health Grading Scale
E) World Health Organization Injury Scale
B) American Association for the Surgery of Trauma-Organ Injury Scale
Explanation: Best et al. validate the American Association for the Surgery of Trauma-Organ Injury Scale grading scale in their study on traumatic ureteral injuries, emphasizing its importance in clinical assessment.
p.10
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What is the most common cause of traumatic ureteral injuries?
A) Iatrogenic causes
B) Sports injuries
C) Penetrating trauma
D) Falls
E) Motor vehicle accidents
C) Penetrating trauma
Explanation: Most traumatic ureteral injuries are due to penetrating trauma, and they are more common in younger males, highlighting the demographic and nature of such injuries.
p.2
Overview of Ureteral Injury
What is the primary function of the ureters?
A) To filter blood
B) To convey urine from the renal pelvis to the bladder
C) To produce urine
D) To store urine
E) To regulate blood pressure
B) To convey urine from the renal pelvis to the bladder
Explanation: The ureters are tubular structures specifically designed to transport urine from the renal pelvis to the bladder, playing a crucial role in the urinary system.
p.8
Surgical Techniques for Ureteral Repair
What is the preferred approach when tissue viability is questionable in ureteral injuries?
A) Observation and monitoring
B) Excision and ureteral reconstruction
C) Immediate stent placement
D) Antibiotic therapy
E) Urgent nephrectomy
B) Excision and ureteral reconstruction
Explanation: When tissue viability is in question, excision and ureteral reconstruction are strongly preferred to ensure proper healing and function of the ureter.
p.13
Imaging Techniques for Ureteral Injury Diagnosis
What is the focus of the study by Miller KS and McAninch JW published in 1995?
A) Imaging techniques for lung trauma
B) Radiographic assessment of renal trauma
C) Surgical techniques for kidney transplantation
D) Management of urinary tract infections
E) Prevention strategies for renal disease
B) Radiographic assessment of renal trauma
Explanation: The study by Miller KS and McAninch JW specifically addresses the radiographic assessment of renal trauma, detailing their 15-year experience in this area.
p.13
Imaging Techniques for Ureteral Injury Diagnosis
What does the study by Haste AK et al. focus on?
A) The role of ultrasound in renal trauma
B) Diagnostic yield and clinical utility of abdominopelvic CT after laparotomy
C) Surgical techniques for ureteral repair
D) Complications associated with renal surgery
E) Prevention strategies for urinary tract injuries
B) Diagnostic yield and clinical utility of abdominopelvic CT after laparotomy
Explanation: This study evaluates the diagnostic yield and clinical utility of abdominopelvic CT scans following emergent laparotomy for trauma, emphasizing its relevance in trauma assessment.
p.4
Clinical Presentation and Diagnosis of Ureteral Injury
Which of the following is NOT a clinical feature that may suggest ureteral injury?
A) Flank pain
B) Flank ecchymosis
C) Posterior rib fracture
D) Hematuria
E) Spine fractures
D) Hematuria
Explanation: While hematuria is often associated with renal injuries, it is an unreliable finding for ureteral injuries, as it is present in less than half of patients with such injuries.
p.15
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What type of injuries are discussed by Brandes et al.?
A) Iatrogenic injuries
B) Ureteral injuries from penetrating trauma
C) Congenital abnormalities
D) Chronic injuries
E) Post-surgical complications
B) Ureteral injuries from penetrating trauma
Explanation: Brandes et al. focus on ureteral injuries resulting from penetrating trauma, which is critical for understanding the mechanisms and management of such injuries.
p.6
Imaging Techniques for Ureteral Injury Diagnosis
What is the purpose of a low-dose 'CT urinoma' study?
A) To enhance parenchymal imaging
B) To reduce radiation exposure during repeat CT imaging
C) To diagnose kidney stones
D) To assess blood flow in the kidneys
E) To visualize the bladder in detail
B) To reduce radiation exposure during repeat CT imaging
Explanation: The low-dose 'CT urinoma' study is specifically designed to minimize radiation exposure while still allowing for adequate imaging of the ureters, particularly when initial images do not provide sufficient opacification.
p.3
Types of Ureteral Injury: Traumatic vs. Iatrogenic
During which type of procedures do most iatrogenic ureteral injuries occur?
A) Urologic procedures
B) Colorectal procedures
C) Vascular procedures
D) Gynecologic procedures
E) General surgery procedures
D) Gynecologic procedures
Explanation: Most iatrogenic ureteral injuries (55 percent) occur during gynecologic procedures, indicating a significant risk associated with this type of surgery.
p.3
Clinical Presentation and Diagnosis of Ureteral Injury
What is the incidence of iatrogenic injury during laparoscopic colectomy compared to open surgery?
A) 0.53 percent for open surgery and 0.66 percent for laparoscopic
B) 0.66 percent for open surgery and 0.53 percent for laparoscopic
C) 1.00 percent for both
D) 0.25 percent for laparoscopic and 0.75 percent for open
E) 0.10 percent for laparoscopic and 0.20 percent for open
B) 0.66 percent for open surgery and 0.53 percent for laparoscopic
Explanation: The incidence of iatrogenic injury during laparoscopic colectomy is 0.53 percent, while it is slightly higher at 0.66 percent for open surgery, suggesting laparoscopic approaches may have a lower risk.
p.7
Surgical Techniques for Ureteral Repair
What is the management option for complete ureteral transections?
A) Observation
B) Perinephric tube placement and formal repair
C) Immediate surgical repair
D) Ureteral stenting
E) Pain management
B) Perinephric tube placement and formal repair
Explanation: For complete ureteral transections, a perinephric tube can be placed, and formal repair should ideally be performed within the first seven days after injury, depending on the patient's clinical status.
p.22
Surgical Techniques for Ureteral Repair
Which of the following is NOT a reconstruction option for long-segment ureteral injury?
A) Ileal ureter interposition
B) Boari flap
C) Psoas hitch
D) Ureteral reimplantation
E) None of the above
D) Ureteral reimplantation
Explanation: Ureteral reimplantation is typically not used for long-segment injuries, while ileal ureter interposition, Boari flap, and psoas hitch are considered options, with ileal ureter being used when the others are not viable.
p.2
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What percentage of genitourinary trauma does ureteral trauma comprise?
A) 5 percent
B) 10 percent
C) <1 percent
D) 20 percent
E) 50 percent
C) <1 percent
Explanation: Ureteral trauma is very rare, comprising less than 1 percent of blunt and penetrating genitourinary trauma, indicating its infrequency in clinical settings.
p.11
Treatment Options for Ureteral Injury
What treatment is generally required for ureteral injuries?
A) No treatment needed
B) Ureteral stenting for all injuries
C) Ureteral repair or stenting depending on the severity
D) Immediate nephrectomy
E) Antibiotics only
C) Ureteral repair or stenting depending on the severity
Explanation: Ureteral injuries typically require treatment, which may include ureteral stenting for minimal injuries or ureteral repair for more severe cases.
What is a common associated injury with blunt ureteral trauma?
A) Head injury
B) Bowel and vascular injuries
C) Skin lacerations
D) Cardiac injury
E) Pulmonary contusion
B) Bowel and vascular injuries
Explanation: Blunt ureteral injuries are often associated with bowel and vascular injuries due to the close anatomical relationships between these structures.
p.20
Surgical Techniques for Ureteral Repair
What type of injury does the Boari flap technique address?
A) Minor lacerations
B) Extensive damage
C) Infections
D) Congenital abnormalities
E) Tumors
B) Extensive damage
Explanation: The Boari flap technique is indicated for cases of extensive damage to the ureters, particularly in the middle third, highlighting its role in complex surgical repairs.
p.23
Imaging Techniques for Ureteral Injury Diagnosis
What imaging technique is used to assess the renal trauma?
A) MRI
B) X-ray
C) Ultrasound
D) CT scan
E) PET scan
D) CT scan
Explanation: The CT scan is the imaging technique used to evaluate the grade IV renal trauma and the subsequent development of a urinoma.
p.1
Overview of Ureteral Injury
What type of injuries are often associated with traumatic ureteral injuries?
A) Minor cuts and bruises
B) Other severe injuries
C) Only soft tissue injuries
D) Fractures of the fingers
E) Skin infections
B) Other severe injuries
Explanation: Traumatic ureteral injuries are frequently associated with other severe injuries, indicating that they often occur in the context of more extensive trauma.
p.18
Surgical Techniques for Ureteral Repair
What does the term 'anastomosis' refer to in the context of ureteroureterostomy?
A) The removal of a section of the ureter
B) The connection of two ureter segments
C) The diversion of urine flow
D) The insertion of a stent
E) The repair of the bladder
B) The connection of two ureter segments
Explanation: Anastomosis refers to the surgical connection of two segments of the ureter, which is the main goal of the ureteroureterostomy procedure.
p.9
Treatment Options for Ureteral Injury
What is the preferred method for urinary drainage in hemodynamically unstable patients with ureteral injury?
A) Immediate ureteral reconstruction
B) Placement of a nephrostomy tube
C) Externalized ureteral stent
D) Observation
E) Bladder catheterization only
B) Placement of a nephrostomy tube
Explanation: In hemodynamically unstable patients due to severe concomitant injuries, the author prefers placement of a nephrostomy tube to prevent complications associated with other drainage options.
p.22
Surgical Techniques for Ureteral Repair
What is the primary indication for ileal ureter interposition?
A) Short-segment ureteral injury
B) Long-segment ureteral injury/stricture
C) Bladder cancer
D) Kidney stones
E) Ureteral diverticulum
B) Long-segment ureteral injury/stricture
Explanation: Ileal ureter reconstruction is specifically indicated for long-segment ureteral injuries or strictures when other reconstruction options, such as Boari flap or psoas hitch, are not viable.
p.6
Treatment Options for Ureteral Injury
What is a common treatment for worsening urinary extravasation in conservatively managed ureteral injuries?
A) Open surgery
B) Antibiotics
C) Placement of a ureteral stent and urethral catheter
D) Bed rest
E) Increased fluid intake
C) Placement of a ureteral stent and urethral catheter
Explanation: For patients showing worsened urinary extravasation on repeat imaging, the placement of a ureteral stent and urethral catheter is a common treatment to alleviate pressure and promote healing.
p.10
Clinical Presentation and Diagnosis of Ureteral Injury
What should clinicians assess for when new symptoms occur after initial trauma stabilization?
A) Ureteral injury
B) Kidney stones
C) Appendicitis
D) Gallbladder disease
E) Pancreatitis
A) Ureteral injury
Explanation: Clinicians should be mindful to assess for potential ureteral injury when new symptoms such as fever, flank pain, sepsis, and/or ileus occur following initial trauma stabilization or pelvic surgery.
p.11
Clinical Presentation and Diagnosis of Ureteral Injury
What is the most sensitive method to assess for ureteral injury in the operating room?
A) CT scan
B) Direct inspection of the ureters
C) Ultrasound
D) MRI
E) Blood tests
B) Direct inspection of the ureters
Explanation: Direct inspection of the ureters during surgery is the most sensitive method for assessing ureteral injury, allowing for immediate identification and potential repair.
p.16
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What is the description of a Grade I ureter injury?
A) Complete transection with >2 cm devascularization
B) Avulsion with <2 cm devascularization
C) Contusion or hematoma without devascularization
D) ≥ 50% transection
E) <50% transection
C) Contusion or hematoma without devascularization
Explanation: A Grade I ureter injury is characterized by a contusion or hematoma that occurs without any devascularization, indicating a minor injury.
p.1
Overview of Ureteral Injury
What is the most common cause of ureteral injury?
A) Traumatic injury from sports
B) Iatrogenic injury during pelvic surgery
C) Infection
D) Congenital defects
E) Chemical exposure
B) Iatrogenic injury during pelvic surgery
Explanation: Ureteral injury is often iatrogenic, occurring during pelvic surgeries such as gynecologic, urologic, or colorectal procedures, making it a significant concern in surgical practice.
p.15
Clinical Presentation and Diagnosis of Ureteral Injury
What is the focus of the audit conducted by Butler et al. on ureteroscopies?
A) Patient satisfaction
B) Intra-operative complications
C) Post-operative recovery
D) Cost-effectiveness
E) Surgical techniques
B) Intra-operative complications
Explanation: The audit by Butler et al. specifically focuses on intra-operative complications during ureteroscopies, emphasizing the need for proactive management of ureteric calculi.
p.21
Surgical Techniques for Ureteral Repair
Where is the autotransplanted kidney placed during the procedure?
A) In the abdominal cavity
B) In the thoracic cavity
C) In the iliac fossa
D) In the lumbar region
E) In the pelvic cavity
C) In the iliac fossa
Explanation: The autotransplanted kidney is specifically placed in the iliac fossa, which is a common site for such procedures, especially when addressing issues related to the proximal ureter.
p.18
Surgical Techniques for Ureteral Repair
What is the primary purpose of ureteroureterostomy?
A) To remove the ureter
B) To connect two segments of the ureter
C) To replace the bladder
D) To divert urine to the skin
E) To repair the kidney
B) To connect two segments of the ureter
Explanation: Ureteroureterostomy is a surgical procedure aimed at connecting the proximal and distal portions of the ureter, allowing for the continuity of urine flow.
p.10
Complications Associated with Ureteral Injury
What complication can develop following a collecting system or ureteral injury that does not heal?
A) Renal failure
B) Perinephric urinoma
C) Ureteral stricture
D) Hydronephrosis
E) Bladder rupture
B) Perinephric urinoma
Explanation: A perinephric urinoma can develop as a complication following a collecting system or ureteral injury that fails to heal, indicating a serious condition that requires medical attention.
p.7
Surgical Techniques for Ureteral Repair
When should iatrogenic urinary tract injury recognized during surgery be repaired?
A) After the patient recovers
B) Intraoperatively when identified
C) Only if the patient requests it
D) After a follow-up appointment
E) Only if there are no other injuries
B) Intraoperatively when identified
Explanation: Iatrogenic urinary tract injuries recognized during surgery should ideally be repaired intraoperatively to prevent complications and ensure timely management of the injury.
p.7
Treatment Options for Ureteral Injury
What is the recommended management for iatrogenic injuries that occur during endoscopic procedures?
A) Immediate surgery
B) Ureteral stent placement
C) Observation
D) Pain management
E) Antibiotic therapy
B) Ureteral stent placement
Explanation: For iatrogenic injuries occurring during endoscopic procedures, the initial management typically involves the placement of a ureteral stent to divert urine and manage the injury effectively.
p.22
Surgical Techniques for Ureteral Repair
How is the ileal segment connected in ileal ureter interposition?
A) To the kidney proximally and to the urethra distally
B) To the ureter proximally and to the bladder distally
C) To the bladder proximally and to the urethra distally
D) To the colon proximally and to the bladder distally
E) To the kidney distally and to the urethra proximally
B) To the ureter proximally and to the bladder distally
Explanation: The ileal segment is sutured to the ureter proximally and to the bladder distally, allowing for the passage of urine from the kidney to the bladder through the reconstructed segment.
p.8
Surgical Techniques for Ureteral Repair
Which surgical technique is NOT mentioned for ureteral repair?
A) Primary reapproximation
B) Spatulated ureteroureterostomy
C) Ureteral reimplantation
D) Ureteral ligation
E) Ureteral bypass
E) Ureteral bypass
Explanation: The text discusses primary reapproximation, spatulated ureteroureterostomy, and ureteral reimplantation, but does not mention ureteral bypass as a surgical technique for repair.
p.20
Surgical Techniques for Ureteral Repair
In which part of the ureter is the Boari flap technique primarily used?
A) Upper third
B) Lower third
C) Middle third
D) Entire ureter
E) None of the above
C) Middle third
Explanation: The Boari flap technique is utilized specifically for the repair of the middle third of the ureters that have been extensively damaged.
p.23
Complications Associated with Ureteral Injury
What complication is observed in the delayed phase of the CT scan?
A) Hematoma
B) Urinoma
C) Abscess
D) Hydronephrosis
E) Renal cyst
B) Urinoma
Explanation: The delayed phase of the CT scan shows progression to a urinoma, which is a collection of urine outside the urinary tract, indicating a complication following the renal trauma.
p.1
Clinical Presentation and Diagnosis of Ureteral Injury
How are ureteral injuries typically recognized?
A) Through routine blood tests
B) Only during autopsy
C) Based on clinical suspicion and specific evaluation
D) By imaging techniques alone
E) By patient self-reporting
C) Based on clinical suspicion and specific evaluation
Explanation: Ureteral injuries may only be recognized early if there is a high clinical suspicion and specific evaluation is conducted, emphasizing the need for awareness in clinical settings.
p.9
Treatment Options for Ureteral Injury
What is the initial management for severe collecting system injuries?
A) Immediate surgery
B) Ureteral stent and bladder catheter or nephrostomy tube placement
C) Autotransplantation
D) Ligation of the ureter
E) Observation only
B) Ureteral stent and bladder catheter or nephrostomy tube placement
Explanation: For severe collecting system injuries, the recommended acute management involves placing a ureteral stent and bladder catheter or nephrostomy tube, followed by delayed ureteral reconstruction.
p.3
Treatment Options for Ureteral Injury
What is the primary benefit of treating ureteral injuries at the time of injury?
A) It reduces the need for follow-up care
B) It is associated with the least morbidity
C) It guarantees complete recovery
D) It eliminates the need for surgery
E) It prevents all complications
B) It is associated with the least morbidity
Explanation: Treating ureteral injuries at the time of injury is crucial as it is associated with the least morbidity, highlighting the importance of timely intervention in surgical settings.
p.10
Clinical Presentation and Diagnosis of Ureteral Injury
What are common symptoms of perinephric urinoma?
A) Nausea and vomiting
B) Fever, chills, and flank pain
C) Headache and dizziness
D) Abdominal swelling and diarrhea
E) Chest pain and shortness of breath
B) Fever, chills, and flank pain
Explanation: Patients with perinephric urinoma typically present with fever, chills, and/or flank pain, usually occurring 7 to 10 days after the acute injury.
p.10
Imaging Techniques for Ureteral Injury Diagnosis
What imaging technique is used to diagnose ureteral injury in hemodynamically stable patients?
A) X-ray
B) Ultrasound
C) MRI
D) Contrast-enhanced CT scan
E) PET scan
D) Contrast-enhanced CT scan
Explanation: The diagnosis of ureteral injury in hemodynamically stable patients is typically made using a contrast-enhanced computed tomography (CT) scan of the abdomen/pelvis.
p.19
Surgical Techniques for Ureteral Repair
What anatomical structure is primarily involved in the psoas hitch ureteral reimplantation?
A) The kidney
B) The urethra
C) The bladder
D) The prostate
E) The diaphragm
C) The bladder
Explanation: The psoas hitch ureteral reimplantation primarily involves the bladder, as the procedure focuses on mobilizing and anchoring the bladder to the psoas muscle while reimplanting the ureter.
p.14
Treatment Options for Ureteral Injury
What innovative approach is discussed by Koukouras et al. in their 2010 study?
A) Open surgery for ureteral injuries
B) Laparoscopic techniques for ureteral injuries
C) Percutaneous minimally invasive management of iatrogenic ureteral injuries
D) Traditional methods of ureteral repair
E) Robotic surgery for ureteral injuries
C) Percutaneous minimally invasive management of iatrogenic ureteral injuries
Explanation: Koukouras et al. discuss the percutaneous minimally invasive management of iatrogenic ureteral injuries, highlighting advancements in treatment techniques.
p.11
Imaging Techniques for Ureteral Injury Diagnosis
What is recommended if suspicion of ureteral injury remains high after a negative CT scan?
A) Immediate surgery
B) Retrograde pyelogram
C) Observation
D) MRI
E) Ultrasound
B) Retrograde pyelogram
Explanation: If suspicion of ureteral injury remains high despite a negative CT scan, a retrograde pyelogram is recommended to further investigate the condition.
p.11
Clinical Presentation and Diagnosis of Ureteral Injury
What can be used intraoperatively to aid in the assessment of ureteral injury?
A) Contrast dye
B) Antibiotics
C) Pain medication
D) Blood transfusion
E) Sedatives
A) Contrast dye
Explanation: Intraoperatively, intravenous dyes such as methylene blue or indigo carmine can be used to help assess for ureteral injury by looking for dye leakage along the ureter.
p.1
Treatment Options for Ureteral Injury
What is a common treatment option for ureteral injuries?
A) Antibiotics only
B) Placement of a ureteral stent
C) Bed rest
D) Physical therapy
E) Chemotherapy
B) Placement of a ureteral stent
Explanation: Treatment for ureteral injuries may include the placement of a ureteral stent or surgical repair, depending on the severity and location of the injury.
p.23
Overview of Ureteral Injury
Which kidney is affected by the grade IV blunt renal trauma?
A) Right kidney
B) Left kidney
C) Both kidneys
D) Neither kidney
E) Unknown
B) Left kidney
Explanation: The CT scan indicates that the left kidney is involved in the grade IV blunt renal trauma.
p.9
Treatment Options for Ureteral Injury
What is the recommended management for complex ureteral injuries?
A) Immediate ureteral reconstruction
B) Autotransplant or ileal ureter interposition
C) Ligation of the ureter
D) Placement of a nephrostomy tube
E) Use of externalized ureteral stent
B) Autotransplant or ileal ureter interposition
Explanation: Autotransplant or ileal ureter interposition is reserved for definitive management of complex ureteral injuries and should not be performed in the acute setting, highlighting its role in long-term management.
p.5
Clinical Presentation and Diagnosis of Ureteral Injury
What additional procedure can aid in the evaluation of ureteral injury if CT scan results are inconclusive?
A) Laparoscopy
B) Cystoscopy with retrograde pyelography
C) Endoscopy
D) Colonoscopy
E) Angiography
B) Cystoscopy with retrograde pyelography
Explanation: If there is suspicion of a ureteral injury that is not definitively proven by CT scan, cystoscopy with retrograde pyelography can aid in the evaluation, providing a direct assessment of the ureters.
p.7
Treatment Options for Ureteral Injury
What is the preferred initial management for complicated ureteral injuries with abscess or urinoma formation?
A) Immediate surgical repair
B) Percutaneous nephrostomy with periureteral drainage
C) Observation
D) Ureteral stenting
E) Pain management
B) Percutaneous nephrostomy with periureteral drainage
Explanation: For complicated injuries involving abscess or urinoma, the preferred initial management is percutaneous nephrostomy with periureteral drainage, followed by plans for delayed ureteral reconstruction.
p.18
Surgical Techniques for Ureteral Repair
What is the significance of using absorbable sutures in ureteroureterostomy?
A) They are cheaper than non-absorbable sutures
B) They do not require removal after healing
C) They are stronger than non-absorbable sutures
D) They are easier to handle
E) They are more visible during surgery
B) They do not require removal after healing
Explanation: Absorbable sutures are significant in ureteroureterostomy because they dissolve over time, eliminating the need for a second procedure to remove them once the tissue has healed.
p.6
Overview of Ureteral Injury
What is a general principle regarding traumatic ureteral injuries?
A) They rarely occur with other injuries
B) They should always be treated with medication
C) They often occur with concomitant injuries requiring exploratory laparotomy
D) They can be ignored if asymptomatic
E) They are always treated with minimally invasive techniques
C) They often occur with concomitant injuries requiring exploratory laparotomy
Explanation: Most traumatic ureteral injuries are associated with other injuries that necessitate exploratory laparotomy, indicating the complexity of managing such cases.
p.2
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What can cause iatrogenic ureteral injuries?
A) Only blunt trauma
B) Surgical procedures and endoscopic manipulation
C) Sports injuries
D) Falls
E) Infections
B) Surgical procedures and endoscopic manipulation
Explanation: Iatrogenic ureteral injuries can occur during various surgical procedures in the abdominopelvic and retroperitoneal areas, as well as during endoscopic manipulation, highlighting the risks associated with medical interventions.
p.5
Clinical Presentation and Diagnosis of Ureteral Injury
What is the primary imaging technique used to diagnose ureteral injury?
A) X-ray
B) Ultrasound
C) Contrast-enhanced CT scan
D) MRI
E) PET scan
C) Contrast-enhanced CT scan
Explanation: The diagnosis of ureteral injury is typically made using a contrast-enhanced computed tomography (CT) scan of the abdomen/pelvis with delayed ureter imaging, making it the primary imaging technique for this condition.
p.7
Clinical Presentation and Diagnosis of Ureteral Injury
What should be attempted if ureteral injury is not recognized and presents in a delayed fashion (>7 days)?
A) Immediate surgery
B) Retrograde imaging with ureteral stent placement
C) Observation
D) Antibiotic therapy
E) Pain management
B) Retrograde imaging with ureteral stent placement
Explanation: In cases where ureteral injury is delayed in presentation, retrograde imaging with ureteral stent placement is recommended as an initial approach to manage the injury effectively.
p.19
Surgical Techniques for Ureteral Repair
Where is the cystostomy performed during the psoas hitch procedure?
A) At the dome of the bladder
B) At the base of the bladder
C) Away from the dome
D) At the ureteral junction
E) At the urethra
C) Away from the dome
Explanation: The cystostomy in the psoas hitch ureteral reimplantation is performed away from the dome of the bladder, which is a specific technique to facilitate the reimplantation process.
p.9
Imaging Techniques for Ureteral Injury Diagnosis
What imaging technique is recommended to assess patency of the reconstructed ureter?
A) X-ray
B) MRI
C) Radionuclide scintigraphy (MAG3 renogram)
D) Ultrasound
E) CT scan
C) Radionuclide scintigraphy (MAG3 renogram)
Explanation: Radionuclide scintigraphy, specifically the MAG3 renogram with furosemide, is helpful at 3 and 12 months following ureteral repair to assess the patency of the reconstructed ureter.
p.22
Surgical Techniques for Ureteral Repair
What part of the intestine is used in ileal ureter reconstruction?
A) Duodenum
B) Jejunum
C) Ileum
D) Colon
E) Rectum
C) Ileum
Explanation: In ileal ureter reconstruction, a segment of the ileum is isolated from the intestinal tract and used to create a new ureter, connecting it proximally to the ureter and distally to the bladder.
p.14
Surgical Techniques for Ureteral Repair
What is the main topic of the article by Zinman and Vanni published in 2016?
A) Non-surgical management of urologic trauma
B) Surgical management of urologic trauma and iatrogenic injuries
C) Prevention of urologic injuries
D) Diagnosis of urologic trauma
E) Long-term outcomes of urologic injuries
B) Surgical management of urologic trauma and iatrogenic injuries
Explanation: Zinman and Vanni's article focuses on the surgical management of urologic trauma and iatrogenic injuries, providing valuable information on treatment approaches.
p.12
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What unusual case is discussed in the article by Fomekong et al. (2018)?
A) Ureteral injury during open surgery
B) Ureteral perforation in minimally invasive pedicle screw instrumentation
C) Iatrogenic ureteral injury during laparoscopic surgery
D) Ureteral injury from external violence
E) Ureteral injury in pediatric patients
B) Ureteral perforation in minimally invasive pedicle screw instrumentation
Explanation: The article presents a unique case of ureteral perforation that occurred during minimally invasive pedicle screw instrumentation, emphasizing the risks associated with such procedures.
p.11
Treatment Options for Ureteral Injury
What may be necessary for severe ureteral injuries?
A) Immediate repair
B) Ligation of the ureter with urinary drainage and delayed reconstruction
C) Observation
D) Urinary catheterization only
E) No intervention required
B) Ligation of the ureter with urinary drainage and delayed reconstruction
Explanation: For severe ureteral injuries, ligation of the ureter with urinary drainage and delayed reconstruction may be necessary to manage the injury effectively.
p.19
Surgical Techniques for Ureteral Repair
What is the primary purpose of the psoas hitch ureteral reimplantation procedure?
A) To remove the bladder
B) To anchor the bladder to the psoas muscle
C) To create a new bladder
D) To increase bladder capacity
E) To perform a kidney transplant
B) To anchor the bladder to the psoas muscle
Explanation: The psoas hitch ureteral reimplantation procedure involves mobilizing the bladder and anchoring it to the psoas muscle using nonabsorbable sutures, which is crucial for stabilizing the bladder during the reimplantation of the ureter.
p.5
Imaging Techniques for Ureteral Injury Diagnosis
What is the recommended delay after administering intravenous contrast for optimal ureteral imaging?
A) 5 minutes
B) 10 minutes
C) 15 minutes
D) 20 minutes
E) 30 minutes
B) 10 minutes
Explanation: Identification of ureteral injuries requires a delay of 10 minutes after the administration of intravenous contrast to allow the contrast to reach the ureters, which is crucial for accurate imaging.
p.5
Clinical Presentation and Diagnosis of Ureteral Injury
What findings may suggest ureteral injury on imaging?
A) Increased blood flow
B) Nonvisualization of the ureter
C) Normal renal function
D) Decreased urine output
E) Increased bladder volume
B) Nonvisualization of the ureter
Explanation: Findings that suggest ureteral injury include nonvisualization of the ureter, contrast extravasation from the ureter, ipsilateral hydronephrosis, and poor renal excretion, which are critical indicators during diagnosis.
p.14
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What type of injuries does Azimuddin et al. focus on in their 1998 study?
A) Iatrogenic ureteric injuries
B) Penetrating ureteric injuries
C) Ureteral injuries during childbirth
D) Ureteral injuries from sports
E) Ureteral injuries from falls
B) Penetrating ureteric injuries
Explanation: Azimuddin et al. specifically study penetrating ureteric injuries, providing insights into their management and outcomes, which is crucial for understanding traumatic ureteral injuries.
p.22
Surgical Techniques for Ureteral Repair
What is the main advantage of using ileal ureter interposition?
A) It is less invasive than other methods
B) It allows for reconstruction when other methods are not possible
C) It requires no suturing
D) It uses a segment of the colon
E) It is a temporary solution
B) It allows for reconstruction when other methods are not possible
Explanation: The main advantage of ileal ureter interposition is its ability to provide a solution for long-segment ureteral injuries when other reconstruction techniques, such as Boari flap or psoas hitch, are not feasible.
p.8
Imaging Techniques for Ureteral Injury Diagnosis
What imaging technique is recommended after stent placement to assess ureteral healing?
A) X-ray
B) Ultrasound
C) MRI
D) Contrast-enhanced CT scan with delayed images
E) Plain CT scan
D) Contrast-enhanced CT scan with delayed images
Explanation: A contrast-enhanced CT scan with delayed images or a retrograde pyelogram is recommended to assess appropriate ureteral healing before or after stent removal.
p.16
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What defines a Grade II ureter injury?
A) Complete transection with <2 cm devascularization
B) Avulsion with >2 cm of devascularization
C) <50% transection
D) ≥ 50% transection
E) Contusion or hematoma without devascularization
C) <50% transection
Explanation: A Grade II ureter injury is defined as a laceration with less than 50% transection of the ureter, indicating a moderate level of injury.
p.19
Surgical Techniques for Ureteral Repair
What does part (B) of the psoas hitch ureteral reimplantation represent?
A) The removal of the ureter
B) The reimplanted ureter and anchored bladder
C) The incision made in the bladder
D) The insertion of a catheter
E) The closure of the abdominal wall
B) The reimplanted ureter and anchored bladder
Explanation: Part (B) represents the reimplanted ureter, the anchored bladder, and the closed cystostomy, illustrating the successful completion of the psoas hitch procedure.
p.19
Surgical Techniques for Ureteral Repair
What type of sutures are used to anchor the bladder to the psoas muscle in the psoas hitch procedure?
A) Absorbable sutures
B) Nonabsorbable sutures
C) Silk sutures
D) Catgut sutures
E) Nylon sutures
B) Nonabsorbable sutures
Explanation: Nonabsorbable sutures are used to anchor the bladder to the psoas muscle during the psoas hitch ureteral reimplantation, ensuring long-term stability of the bladder position.
p.3
Complications Associated with Ureteral Injury
What factor may influence the risk of complications related to laparoscopic surgery?
A) The type of anesthesia used
B) The experience of the surgeon
C) The age of the patient
D) The duration of the surgery
E) The type of surgical instruments used
B) The experience of the surgeon
Explanation: The risk for complications related to laparoscopic surgery may depend on the experience of the surgeon, indicating that surgical skill plays a critical role in patient outcomes.
p.2
Overview of Ureteral Injury
Which structures protect the ureters within the retroperitoneum?
A) Lungs and heart
B) Visceral organs, psoas muscles, vertebrae, and pelvic bones
C) Skin and muscles
D) Liver and spleen
E) Kidneys and bladder
B) Visceral organs, psoas muscles, vertebrae, and pelvic bones
Explanation: The ureters are well protected within the retroperitoneum by surrounding visceral organs, psoas muscles, vertebrae, and pelvic bones, which help shield them from injury.
p.12
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What did Marcelissen et al. (2016) investigate?
A) Ureteral injuries in pediatric patients
B) Incidence of iatrogenic ureteral injury during colorectal surgery
C) Ureteral injuries from external trauma
D) Long-term outcomes of ureteral injuries
E) Surgical techniques for ureteral repair
B) Incidence of iatrogenic ureteral injury during colorectal surgery
Explanation: The study by Marcelissen et al. focused on the incidence of iatrogenic ureteral injuries specifically during open and laparoscopic colorectal surgery, contributing to the understanding of surgical risks.
p.8
Surgical Techniques for Ureteral Repair
What is recommended for distal ureteral injuries?
A) Primary closure
B) Ureteral ligation
C) Ureteral reimplantation to the bladder
D) Spatulated ureteroureterostomy
E) Immediate nephrectomy
C) Ureteral reimplantation to the bladder
Explanation: For distal ureteral injuries, ureteral reimplantation of the proximal injured ureter to the bladder is recommended to restore function.
p.16
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What is the injury type for a Grade III ureter injury?
A) Hematoma
B) Complete transection
C) Avulsion
D) Laceration
E) Contusion
D) Laceration
Explanation: A Grade III ureter injury involves a laceration that results in 50% or more transection of the ureter, indicating a more severe injury compared to Grade II.
p.16
Types of Ureteral Injury: Traumatic vs. Iatrogenic
Which grade of ureter injury involves complete transection with less than 2 cm of devascularization?
A) Grade I
B) Grade II
C) Grade III
D) Grade IV
E) Grade V
D) Grade IV
Explanation: A Grade IV ureter injury is characterized by complete transection of the ureter with less than 2 cm of devascularization, indicating a severe injury.
p.16
Types of Ureteral Injury: Traumatic vs. Iatrogenic
What is the defining characteristic of a Grade V ureter injury?
A) Contusion without devascularization
B) Laceration with <50% transection
C) Complete transection with <2 cm devascularization
D) Avulsion with >2 cm of devascularization
E) Laceration with ≥ 50% transection
D) Avulsion with >2 cm of devascularization
Explanation: A Grade V ureter injury is defined as an avulsion that results in more than 2 cm of devascularization, representing the most severe type of injury on the scale.
