Ureteral injury from blunt force trauma is rare, with an incidence of less than 1%, compared to 4% in penetrating trauma. In addition, isolated ureteral injuries are rare, with associated injuries in 90% of cases.

A 21-year-old female presented to the emergency department after a motor vehicle collision. She was haemodynamically stable and of normal consciousness. She had bruising to the left flank and computed tomography (CT) demonstrated a subcutaneous haematoma and retroperitoneal fluid but no underlying urinary tract injury. Repeat CT intravenous pyelogram (IVP) ten days la ter revealed increased size of the retroperitoneal fluid collection with contrast extravasation arising from a defect in the proximal ureter at the level of L3. There was no extravasation from the kidney and renal parenchyma was intact. She then underwent retrograde ureteric stent placement. Retrograde pyelogram (RGP) similarly demonstrated contrast extravasation at the left proximal ureter, with no contrast extravasation from the kidney. Initial attempts to pass a guidewire to the kidney were unsuccessful, as the wire repeatedly coiled outside the ureter. Both rigid and flexible ureteroscopy were attempted but abandoned due to an inability to pass the ureter. Eventually, a guidewire was successfully passed to the kidney, and a 6Fr ureteric stent was placed into the upper calyx. Repeat cysto/ureteroscopy and RGP two months later demonstrated a blind ending in the left ureter at this previous site of difficulty. Both contrast and a wire were unable to pass this obstruction, and there were unsuccessful attempts to traverse it with ureteroscopy. An antegrade stent attempt was also unsuccessful, as there was a very tight short stricture at the proximal ureter and pelviureteric junction and again a wire was unable to be passed through. Instead, a nephrostomy was placed.

Currently, the patient has a nephrostomy and urethral indwelling catheter for maximal urinary drainage. Definitive attempts at reconstruction are being considered. A literature search demonstrated eight cases of isolated blunt ureteric injury. Common clinical features included nausea, vomiting, bruising flank/abdominal pain, and haematuria. Diagnosis was made on CT IVP, including one case with normal initial imaging but evidence of injury on repeat CT. All cases demonstrated contrast extravasation, with the presence of significant retroperitoneal fluid or absence of contrast in the distal ureter being less common findings. Seven cases were successfully managed with ureteric stent placement, despite a range of different severities and locations of injury. One patient underwent successfully ureteroureterostomy.

Although isolated blunt ureteral injury is rare, it should be considered in patients with relevant clinical features despite an absence of injury on initial imaging. Ureteric stent placement is often successful, although alternative reconstructive techniques may be required.