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Wang W, Xiao B, Huang X, Yu J, Xi Y, Xu G, Ye X. Diagnosis and treatment of left ureteral injury as a rare complication of oblique lumbar interbody fusion surgery: a case report and literature review. BMC Urol 2022; 22:146. [PMID: 36076193 PMCID: PMC9461179 DOI: 10.1186/s12894-022-01070-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/22/2022] [Indexed: 11/04/2022] Open
Abstract
Background Oblique lumbar interbody fusion (OLIF) surgery has been performed as a minimally invasive lateral lumbar fusion technique in recent years. Reports of operative complications of OLIF are limited, and there are fewer reports of ureteral injuries. Case presentation A 62-year-old Chinese woman diagnosed with "lumbar spondylolisthesis (L4 forward slip, I degree)" underwent OLIF treatment. The surgical decompression process was smooth, and the cage was successfully placed. After the expansion sleeve of OLIF was removed, clear liquid continuous outflow from the peritoneum was found. The patient was diagnosed with a ureteral injury. The urological surgeon expanded the original incision, and left ureteral injury anastomosis and ureteral stent implantation were performed. The patient was changed to the prone position and a percutaneous pedicle screw was placed in the corresponding vertebral body. The patient was indwelled with a catheter for 2 weeks, and regular oral administration of levofloxacin to prevent urinary tract infection. After 2 months, the double J tube was removed using a cystoscope. One year after surgery, the symptoms of lumbar back were significantly improved, and there were no urinary system symptoms. However, the patient needed an annual left ureter and kidney B-ultrasound. Conclusion Ureteral injury is a rare complication and is easily missed in OLIF surgery. If the diagnosis is missed, the consequences can be serious. Patients should undergo catheterization before the operation and hematuria should be observed during the operation. We emphasize the careful use of surgical instruments to prevent intraoperative complications. In addition, after withdrawing the leaf in the operation, it is necessary to carefully observe whether a clear liquid continues to leak. If ureteral injury is found, one-stage ureteral injury repair operation should be performed to prevent ureteral stricture.
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Affiliation(s)
- Weiheng Wang
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Bing Xiao
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Xiaodong Huang
- Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, Guangdong, 510140, China
| | - Jiangming Yu
- Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Yanhai Xi
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Guohua Xu
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China.
| | - Xiaojian Ye
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China. .,Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
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Ureteral Injury Following Posterior Lumbar Interbody Fusion After Five Years: A Rare Case. Nephrourol Mon 2022. [DOI: 10.5812/numonthly.120605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Ureteral injuries are considered as rare complications of posterior lumbar interbody fusion (PLIF). There are few reports in the literature on ureteral injuries following PLIF. The present report presented a case of right ureteral injury by passing five years from PLIF. Case Presentation: The patient was a 51-year-old woman who has been referred to urologist with the complaints of flank pain, fever, anorexia, vomiting, and nausea, and a history of PLIF five years ago. After radiological examinations, ureteral obstruction was diagnosed and then open surgery was performed. Severe adhesions and fibrosis were observed in the retroperitoneal next to the lumbar vertebra implant. Thereafter, the ureteral stenosis was removed, the ureter was anastomosed end-to-end, and Double J was placed. The anastomosis site was covered with a flap of perinephric adipose tissue in order to prevent re-fibrosis. Conclusions: This report aimed to inform surgeons of a rare complication, a ureteral injury that has happened five years after PLIF, along with its non-specific signs.
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Testa EJ, Alam SM, Kahan LG, Ziegler O, DeFroda S. Genitourinary complications in orthopaedic surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:201-210. [PMID: 33782736 DOI: 10.1007/s00590-021-02944-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
Genitourinary complications following orthopaedic intervention are uncommon but well-described occurrences and exist on a spectrum of severity. These complications vary depending on the anatomic location and surgical approach, with surgery of the spine, hip, and pelvis of particular concern. Injuries to the urinary tract may present acutely with urinary retention or hematuria. However, they often have a delayed presentation with severe complications such as urinary fistula and recurrent infection. Delayed presentations may place the onus of timely and proper diagnosis on the orthopaedic provider, who may serve as the patient's primary source of long-term follow-up. Detailed knowledge of anatomy and at-risk structures is key to both preventing and identifying injury. Although iatrogenic injury is not always avoidable, early identification can help to facilitate timely evaluation and management to prevent long-term complications such as bladder dysfunction, obstructive renal injury, sexual dysfunction, and chronic pain. Keywords: urologic injury, bladder injury, genitourinary injury, hip arthroplasty, pelvic ring injuries, spine surgery.
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Affiliation(s)
- Edward J Testa
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, United States of America.
| | - Syed M Alam
- Department of Urology, University of Kansas Health System, Kansas City, KS, United States of America
| | - Lindsey G Kahan
- Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Olivia Ziegler
- Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Steven DeFroda
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
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Zhao L, Zeng J, Yang Z, Wang C. [Research progress of ureteral injury in oblique lumbar interbody fusion]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1474-1477. [PMID: 33191709 DOI: 10.7507/1002-1892.202001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To summarize the research progress of ureteral injury in oblique lumbar interbody fusion (OLIF). Methods The literature about incidence, clinical manifestations, diagnosis, and treatment of ureteral injury complications in OLIF was reviewed. Results OLIF surgery poses a risk of ureteral injury because its surgical approach is anatomically adjacent to the left ureter. Ureteral injuries in OLIF are often insidious and have no specific clinical manifestations. CT urography is a common diagnostic method. The treatment of ureteral injury depends on a variety of factors such as the time of diagnosis, the location and degree of injury, and the treatment methods range from endoscopic treatment to replacement reconstruction. Conclusion Surgeons should pay attention not to damage the ureter and find the abnormality in time during OLIF. High vigilance of abnormalities is conducive to the early diagnosis of ureteral injury. Furthermore, it is important to be familiar with ureter anatomy and gentle operation to prevent ureteral injury.
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Affiliation(s)
- Long Zhao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jiancheng Zeng
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Zhiqiang Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Chaoyang Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Hajiha M, Sowerby RJ, Pace KT. A Rare Ureteral Injury Following Posterior Approach Lumbar Discectomy. J Endourol Case Rep 2017; 3:158-161. [PMID: 29142908 PMCID: PMC5684662 DOI: 10.1089/cren.2017.0112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Iatrogenic ureteral injuries account for ∼75% of all ureteral injuries and occur primarily during urologic, gynecologic, general, and vascular surgery procedures. Ureteral injury during spine surgery is a rare complication with only occasional reports in the literature. In this case report, we present a case of unrecognized left ureteral injury during an open right lumbar discectomy with a delayed presentation, and discuss the steps required for diagnosis and management. This report highlights a rare complication during laminectomy and serves to better inform patients and surgeons about this potential complication and the management options.
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Affiliation(s)
- Mohammad Hajiha
- Division of Urology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Robert J Sowerby
- Division of Urology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Kenneth T Pace
- Division of Urology, St. Michael's Hospital, University of Toronto, Toronto, Canada
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Kubota G, Orita S, Umimura T, Takahashi K, Ohtori S. Insidious intraoperative ureteral injury as a complication in oblique lumbar interbody fusion surgery: a case report. BMC Res Notes 2017; 10:193. [PMID: 28587633 PMCID: PMC5461674 DOI: 10.1186/s13104-017-2509-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 05/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oblique lumbar interbody fusion surgery is a recently introduced minimally invasive lateral interbody fusion surgery for degenerative lumbar disease. There have been no reports of associated ureteral injury. CASE PRESENTATION A 77-year-old Japanese woman underwent oblique lumbar interbody fusion surgery for lumbar spondylolisthesis with refractory low back pain and pain in both legs. The patient experienced abdominal pain 2 days after surgery. Delayed contrast-enhanced computed tomography and retrograde urography revealed leakage of contrasted urine from the ureter into the retroperitoneal space, indicating a ureteral injury. Immediate percutaneous nephrostomy was performed to recover her condition, followed by additional ureteral stenting. She is now free from preoperative symptoms but requires periodic changing of the ureteral stent, with no urinary symptoms. CONCLUSION The current report described a rare but possible case of ureteral injury following oblique lumbar interbody fusion surgery. Iatrogenic ureteral injury, as reported in the current case, is uncommon following oblique lumbar interbody fusion surgery, and the injury may have been caused by a procedural error. Considering the findings from urological examinations, we speculate that the thread pin that fixates the retractor injured the ureter during its installation. This case highlights the importance of careful attention while exposing the retroperitoneal space to avoid minor organs, including the ureters, as well as major organs. Ureteral injuries should ideally be detected and diagnosed as soon as possible by careful physical and radiological examinations, such as with delayed contrast-enhanced computed tomography and retrograde urography, to salvage the injured nephroureteral system. The current report also highlights that careful use of surgical instruments is key for preventing intraoperative complications, including ureteral injury.
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Affiliation(s)
- Go Kubota
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan.
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
| | - Tomotaka Umimura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
| | - Kazuhisa Takahashi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
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Başer A, Alkış O, Toktaş C, Zümrütbaş AE. A rare cause of ureteral injuries; simultaneous common iliac artery and ureter injury during posterior lumbar disc surgery. Turk J Urol 2016; 42:108-10. [PMID: 27274898 DOI: 10.5152/tud.2016.70105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Major vascular injuries during lumbar disc surgery are rare but well-recognized complications. However, vascular injuries of the branches of the aorta and ureteral injuries are very rare. Although its incidence is not known definitely, it is estimated to be 1/1000. Ureteral injuries comprise less than 1% of all genitourinary traumas. In this article, we report clinical progress of a patient who had simultaneous internal iliac artery and ureteral injury during lumbar discectomy. The patient was managed with primary ureteroureterostomy. To our knowledge, this is the first case reported with simultaneous ureter and iliac artery trauma during lumbar disc surgery.
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Affiliation(s)
- Aykut Başer
- Department of Urology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Okan Alkış
- Department of Urology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Cihan Toktaş
- Department of Urology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Ali Ersin Zümrütbaş
- Department of Urology, Pamukkale University School of Medicine, Denizli, Turkey
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Tsai PJ, Wang HYJ, Lin YS, Yang TM. Laparoscopic ureteral repair for iatrogenic ureteral injury following lumbar disc surgery. FORMOSAN JOURNAL OF SURGERY 2013. [DOI: 10.1016/j.fjs.2013.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
Although ureteric injury is relatively uncommon, it is a serious event that can result in intra-abdominal sepsis, renal failure, and loss of the ipsilateral renal unit. Most injuries are iatrogenic and remain undiagnosed until the patient presents with symptoms postoperatively. In addition to compromising patient safety, missed ureteric injuries frequently result in litigation. Over the past 20 years, there has been a rapid uptake of laparoscopic and robotic techniques within urology and other surgical specialties. This trend, coupled with increased use of ureteroscopy, has increased the risk of injury to the ureter. The key to diagnosing and managing a ureteric injury is to have a low threshold for suspecting its presence. Diagnosis can be achieved using retrograde pyelography, ureteroscopy, CT, or intravenous urography. Initial management should involve ureteric stent placement or percutaneous nephrostomy drainage. In selected patients, surgical reconstruction might be the optimal approach. Decisions regarding surgical technique (open, laparoscopic, or robotic) are guided by the clinical situation and surgical expertise available.
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Ruatti S, Courvoisier A, Eid A, Griffet J. Ureteral injury after percutaneous iliosacral fixation: a case report and literature review. J Pediatr Surg 2012; 47:e13-6. [PMID: 22901936 DOI: 10.1016/j.jpedsurg.2012.03.065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 03/04/2012] [Accepted: 03/10/2012] [Indexed: 11/28/2022]
Abstract
We report a case of right ureter injury in an 11-year-old girl after a percutaneous iliosacral screwing with non-computer-assisted fluoroscopic guidance. The indication was a pelvic ring fracture, C1-1 in the Tile modified AO classification (J Am Acad Orthop Surg. 1996;4:143-151). The mechanism was a ski accident. A percutaneous iliosacral screwing was performed to stabilize the right iliac wing fracture. Twelve days after the initial trauma, a right ureter tear was highlighted, just opposite the fourth lumbar vertebra. Uneventful spontaneous healing of the ureteral injury site occurred following double J-stent catheterization.
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Affiliation(s)
- Sébastien Ruatti
- Pediatric Orthopaedic Surgery Department, CHU de Grenoble, Hôpital Nord. 38700, La Tronche, France.
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Kang SH, Park SW. Symptomatic post-discectomy pseudocyst after endoscopic lumbar discectomy. J Korean Neurosurg Soc 2011; 49:31-6. [PMID: 21494360 DOI: 10.3340/jkns.2011.49.1.31] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 11/13/2010] [Accepted: 12/31/2010] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The objectives of this study were to determine the frequency of symptomatic postdiscectomy pseudocyst (PP) after endoscopic discectomy and to compare the results of surgical and conservative management of them. METHODS Initial study participants were 1,503 cases (1,406 patients) receiving endoscopic lumbar discectomy by 23-member board of neurosurgeons from March 2003 to October 2008. All patients' postoperative magnetic resonance imaging (MRI) scans were evaluated. On the postoperative MRI, cystic lesion of T2W high and T1W low at discectomy site was regarded as PP. Reviews of medical records and radiological findings were done. The PP patients were divided into two groups, surgical and conservative management by treatment modality after PP detection. We compared the results of the two groups using the visual analogue scale (VAS) for low back pain (LBP), VAS for leg pain (LP) and the Oswestry disability index (ODI). RESULTS Among 1,503 cases of all male soldiers, the MRIs showed that pseudocysts formed in 15 patients, about 1.0% of the initial cases. The mean postoperative interval from surgery to PP detection was 53.7 days. Interlaminar approach was correlated with PP formation compared with transforaminal approach (p=0.001). The mean VAS for LBP and LP in the surgical group improved from 6.5 and 4.8 to 2.0 and 2.3, respectively. The mean VAS for LBP and LP in the conservative group improved from 4.4 and 4.4 to 3.9 and 2.3, respectively. There was no difference in treatment outcome between surgical and conservative management of symptomatic PP. CONCLUSION Although this study was done in limited environment, symptomatic PP was detected at two months' postoperative period in about 1% of cases. Interlaminar approach seems to be more related with PP compared with transforaminal approach.
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Affiliation(s)
- Suk Hyung Kang
- Department of Neurological Surgery, Yong-San hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Bjurlin MA, Rousseau LA, Vidal PP, Hollowell CMP. Iatrogenic ureteral injury secondary to a thoracolumbar lateral revision instrumentation and fusion. Spine J 2009; 9:e13-5. [PMID: 19217352 DOI: 10.1016/j.spinee.2008.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 12/04/2008] [Accepted: 12/29/2008] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Marc A Bjurlin
- Department of Surgery, Division of Urology, John H. Stroger, Jr. Hospital of Cook County, 1900 W. Polk Street, Suite 465, Chicago, IL 60612, USA
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