Late diagnosis of ureteral injury from anterior lumbar spine interbody fusion surgery: Case report and literature review

Background: Anterior Lumbosacral Interbody Fusion (ALIF) is a type of back surgery with the advantages of direct access to the spinal interbody space and the potential lessening morbidity related to posterior approaches. Purpose: To describe a rare case of left ureteral lesion from ALIF surgery diagnosed 4 months after the procedure. Case description: A 37-year-old Caucasian man with a long history of painful post-traumatic spondylolisthesis and degenerative L5-S1 disc disease underwent a retroperitoneal anterior L5-S1 discectomy, insertion of an interbody tantallium cage, and placement of a pyramid titanium plate fixed with screws. Four months later, due to recurrent left lumbar pain and mild renal failure, a CT scan was performed showing left hydronephrosis with a homolateral urinoma of 17 cm in diameter. A left nephrostomy was placed and the nephrostography detected a filiform leakage at L5-S1 level in communication with the urinoma. The patient underwent laparoscopic urinoma drainage, distal left ureterectomy, and Casati-Boari flap ureterocystoneostomy with ureteral double J stent placement. The stent was held for six weeks and, 1 month later, the control ultrasound scan was negative for hydronephrosis, the creatinine level had normalized and the patient was asymptomatic. Conclusion: Ureteral lesion from ALIF surgery is a very rare event. Spinal surgeons should be more awareness regarding the susceptibility of ureteral injuries along with the clinical presentation, diagnostic work-up, and management options for this kind of complication.

Ureteral Rupture Caused by Accidental Intubation of the Ureter with a Foley-Catheter during Ureterorenoscopy

We would like to present the case of a 64-year-old woman who underwent ureterorenoscopy and suffered an iatrogenic ureteral lesion due to an accidental intubation of the left ureter with a Foley-Catheter during the procedure. A Double-J-Stent was implanted into the damaged ureter, and 6 weeks later it fully recovered. To our knowledge there are few similar cases described in the literature with none of those having happened during ureterorenoscopy so far.

Reimplante ureteral asistido por robot: técnica quirúrgica y revisión

La mayor parte de las veces las lesiones ureterales son una iatrogenia secundaria a procedimientos quirúrgicos, como la histerectomía por cualquiera de sus vías. La incidencia se incrementa en procedimientos quirúrgicos de mínima invasión y estenosis ureterales por diferentes padecimientos de la vía urinaria. El reimplante ureteral es un procedimiento de dominio obligado del urólogo. Su acceso, a partir del año 2003, es por vía robot asistida.Uno de los objetivos de esta revisión, es describir la técnica quirúrgica del reimplante ureteral asistida por robot y revisar la bibliografía de este procedimiento.Se detalla la técnica quirúrgica utilizada en la atención de una paciente de 46 años de edad con lesión ureteral secundaria a histerectomía. Los resultados mostrados por los diferentes grupos que realizan reimplante ureteral robot asistido muestran un 90% de lesiones ureterales distales la mayoría resueltas por la vía extra vesical.Hoy día muchos grupos realizan cirugía ginecológica asistida con robot y el incidente ureteral es frecuente; por esto, una alternativa resolutiva es el uso del sistema quirúrgico Da Vinci, por la gran precisión en la resolución y la correcta reconstrucción ureteral que permiten la visión 3D y la movilidad y facilidad para la sutura.PALABRAS CLAVE: reimplante ureteral, lesión ureteral, asistencia robótica.

Inverted papilloma of the ureter: study of a rare case with emphasis on clinicopathologic implications

A 62-year old male patient presented complaining of intermittent macroscopic hematuria. The ultrasonographic investigation revealed a hydronephrosis of remarkable degree with indiscreterenal parenchyma. The abdominal computed tomography scan identified a ureteral lesion with proximal dilatation, hydronephrosis and a functionless ipsilateral renal unit. The retrograde urography showed a 4-cm lesion with multiple filling defects and a smooth contour. The endoscopic examination showed an exophytic lesion, highly suspicious for malignancy. Urine cytology revealed atypia. Right nephroureterectomy was performed and the pathology revealed a ureteral inverted papilloma (UIP). Polymerase chain reaction examination for the presence of human papilloma virus, using GP5+/6+ consensus primers, was negative. The presence UIP should be considered in patients with urotheleal lesions in the ureter when the diagnostic workup for malignancy is inconclusive. The clinical course of the disease seems to be favorable.

Combined Radiologic-Urologic Procedure for the Placement of Ureteral Stent in a Case of Bilateral Iatrogenic Ureteral Lesion

Introduction Iatrogenic ureteral lesions are well-known complications of abdominal and pelvic surgery. A combined radiologic-urologic approach might be necessary to repair these lesions. Materials and Methods A 69-year-old woman underwent bilateral hysteroannessectomy for endometrial cancer. She then became anuric. A CT scan showed multiple urinomas caused by bilateral ureteral lesions. The continuity of the two urinary tracts was restored using ureteral stents in a combined urologic and radiologic procedure. Results The patient improved clinically and the renal function returned within normal limits. Conclusions The combined antegrade-retrograde approach is an effective technique to solve iatrogenic ureteral lesions.