Hand-assisted laparoscopic ureteroureterostomy with renal mobilization for delayed recognition of a proximal ureteral injury after lumbar disk surgery
DOI:
https://doi.org/10.5489/cuaj.865Abstract
We present hand-assisted laparoscopic ureteroureterostomy(HALUU) with renal mobilization as a novel approach to the management
of proximal ureteral injury after lumbar disk surgery. A
63-year-old female underwent L4-L5 diskectomy and facetectomy
with cage placement for back and leg pain. Postoperatively, she
developed fever, nausea, abdominal pain, ileus and leukocytosis.
A computed tomography scan of the abdomen and pelvis with
intravenous contrast and delayed imaging demonstrated a left
proximal ureteral injury with contrast extravasation. Retrograde
and antegrade ureteral stent placement was unsuccessful; a nephrostomy
tube was placed. Antegrade and retrograde ureterograms
revealed a 3-cm proximal ureteral defect. All treatment options
were discussed, and the patient chose to undergo hand-assisted
laparoscopic renal mobilization with ureteroureterostomy, which
was completed successfully without complications. Operative
time was 381 minutes; estimated blood loss was 50 mL. The
patient was discharged after 2 days, her ureteral stent was
removed in 8 weeks, and follow-up with furosemide-mercaptoacetyltriglycine
(MAG-3) renal scan demonstrated 30% function
without evidence of obstruction. Hand-assisted laparoscopic
ureteroureterostomy with renal mobilization can be performed
as definitive management of a medium-length proximal ureteral
injury. This is the first case describing this management technique
after lumbar disk surgery.
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How to Cite
Kaffenberger, S., Tomaszewski, J. J., Tsao, A. K., & Jackman, S. V. (2013). Hand-assisted laparoscopic ureteroureterostomy with renal mobilization for delayed recognition of a proximal ureteral injury after lumbar disk surgery. Canadian Urological Association Journal, 4(3), E82-E85. https://doi.org/10.5489/cuaj.865
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