Ureteral injury incident to lumbar disc surgery. Case report

Complete ureteral necrosis after injury sustained during lumbar disc surgery: A case report

INTRODUCTION

Reports pertaining to ureteral injury sustained during lumbar disc surgery are rare; most ureteral injuries in this setting involve laceration or transection.

PATIENT CONCERNS

We report a rare case of a 55-year-old man who presented with complete left ureteral necrosis 20 days after sustaining ureteral transection during lumbar disc surgery.

DIAGNOSIS

The patient presented with seroperitoneum caused by left ureteral injury; post-operative histopathological examination of surgical specimen after discectomy had revealed ureter-like tissue. Exploratory laparoscopic surgery revealed necrosis of a long segment of ureter, which was not amenable to treatment with conventional methods.

INTERVENTION

We used a spiral bladder muscle flap with vascular pedicles to repair the ureteral defect.

OUTCOMES

Post-operative period was uneventful and the patient showed good recovery.

CONCLUSION

Spiral bladder muscle flap with vascular pedicles may be used to repair extensive ureteric injury.

Iatrogenic ureteral injury secondary to a thoracolumbar lateral revision instrumentation and fusion

BACKGROUND CONTEXT

Urologic, gynecologic, and colorectal surgical procedures account for most of the iatrogenic ureteral injuries; however, iatrogenic injury secondary to thoracolumbar spinal surgery remains a rare complication.

PURPOSE

To report a case of iatrogenic ureteral injury secondary to a thoracolumbar lateral revision instrumentation and fusion managed by percutaneous nephrostomy, ureteroureterostomy, and ureteral stent placement.

STUDY DESIGN

Case report.

METHODS

A 24-year old female underwent surgical removal of a lumbar plate and broken screw with placement of a unirod spanning L1-L3 through a thoracolumbar exposure with resection of the twelfth rib.

RESULTS

On postoperative day 14 she developed left flank pain. Computed tomography scan of the abdomen and pelvis demonstrated a left perinephric fluid collection. After placement of a nephrostomy tube, a retrograde pyelogram with a concomitant antegrade nephrostogram confirmed the diagnosis of ureteral entrapment in the lumbar instrumentation. A spatulated end to end ureteral anastomosis (ureteroureterostomy) was performed over a double J ureteral stent.

CONCLUSIONS

Although an iatrogenic ureteral injury secondary to thoracolumbar surgery is rare, it should be included in the differential diagnosis for a patient presenting with flank pain after undergoing lateral thoracolumbar fusion. A urinoma, also an uncommon occurrence, may be a presenting sign. Prompt diagnosis and institution of appropriate corrective surgical procedures may result in successful outcome.

Ureteric injury after lumbosacral discectomy: a case report and review of the literature

Herein, a case of ureteric injury was inflected during lumbo-sacral laminectomy is reported to be added to the previously published 15 cases. Ureteric injury is a rare complication that may be encountered during lumbar disc surgery. We traced 15 cases that were published in literatures allover the past years with different management techniques. To the best of our knowledge, we report the first case that was treated by ileal ureteric replacement. Special attention should be paid regarding ureteric injury during surgery. Despite rare incidence of such injury with laminectomy, there were some reportable complications. So, surgeons should be aware of prediction, early diagnosis, and possible management alternatives for such injuries to safe patients from unsuspected handicapping.

Complete ureteral transection associated with percutaneous lumbar disk nucleotomy

A case of complete ureteral transection complicating percutaneous nucleotomy for disk herniation is reported. The ureteral lesion was contralateral to the percutaneous approach and was treated by intubated ureteroureterostomy, since complete section precluded endourological management.

Iatrogenic ureteral injury

We treated 27 patients with iatrogenic ureteral injuries during a 6-year period. Gynecological operations were the most common antecedent surgical procedures (52 per cent). The diagnosis of ureteral injury was made immediately in 4 patients and was delayed 1 to 34 days in 23. Three of the 4 injuries recognized during an operation were repaired successfully at the time of injury; the primary repair in the remaining patient leaked and ultimately resulted in a nephrectomy. In the delayed diagnosis group retrograde ureteral catheterization was successful in only 1 of 20 attempts. Of the 23 patients with injuries recognized in the postoperative period 11 were managed successfully with percutaneous nephrostomy (with or without stenting) alone, 3 required surgical repair after temporary percutaneous nephrostomy drainage, 4 were treated surgically without prior nephrostomy drainage and 1 had spontaneous resolution of hydronephrosis. The remaining 3 patients required nephrectomy: 1 because of a urinary fistula in a previously irradiated field, 1 because of a concomitant (ipsilateral) renal cell carcinoma and 1 because of renal hypertension. Percutaneous nephrostomy or ureteral stenting was successful as primary therapy in 73 per cent of the patients in whom it was used.

Surgical injury to ureter

The incidence of surgical injury to the ureter varies from as low as 0.5% to as high as 30%. By being aware of various pitfalls in prevention, recognition, and treatment, the operating surgeon may perhaps minimize the incidence of surgical injuries to the ureter or their sequelae. The authors' experience with twenty-four surgical ureteral injuries is discussed and 5 cases are reported. In spite of a thorough knowledge of embryology, anatomy, and pathology predisposing to ureteral involvement, the possibility of ureteral injury must always be kept in mind.