Lai Chien-Jung, Chang Ming-Yuan, Huang Po-Chien, Chu Yuan-Chung
Division of Urology, Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan,
Division of Neurosurgery, Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan.
Res Rep Urol. 2019 Jan 17;11:15-19. doi: 10.2147/RRU.S189259. eCollection 2019.
Ureter avulsion, a challenging urologic complication, has been rarely found in lumbar spine surgeries. Once ignored, the leaked urine usually leads to significant morbidity and also makes further repair more difficult. We present an unusual ureter injury causing a long defect which occurred in posterior spine fusion; immediate repair was performed with minimal invasion.
A 61-year-old female was receiving microscopic spine fusion (transforaminal lumbar interbody fusion) for her L3-L5 spondylosis. Ureter avulsion with one 3-cm defect occurred unexpectedly. We confirmed urine extravasation promptly, and performed end-to-end ureteroureterostomy with laparoscopy. Retrograde double-J stenting was indwelled. Her postoperative condition was uneventful.
This rare case with good outcome highlights the importance of early diagnosis and immediate repair for complete ureter avulsion. We prove that reanastomosis for ureter loss as much as 3 cm is feasible with laparoscopy in regional hospitals where a robot is not available. To deal with large gaps between stumps, adequate kidney mobilization is required before anastomosis.
输尿管撕脱是一种具有挑战性的泌尿外科并发症，在腰椎手术中很少见。一旦被忽视，漏尿通常会导致严重的发病率，也会使进一步修复更加困难。我们报告一例在脊柱后路融合术中发生的不寻常的输尿管损伤，导致长段缺损，采用微创方式进行了即时修复。
一名61岁女性因L3-L5椎体关节强硬接受显微镜下脊柱融合术（经椎间孔腰椎椎体间融合术）。意外发生输尿管撕脱，出现一个3厘米的缺损。我们迅速确认了尿液外渗，并通过腹腔镜进行了输尿管端端吻合术。留置了逆行双J支架。她术后情况平稳。
这例罕见病例取得了良好的结果，突出了早期诊断和即时修复完全性输尿管撕脱的重要性。我们证明，在没有机器人设备的地区医院，腹腔镜下对长达3厘米的输尿管缺损进行再吻合是可行的。为了处理断端之间的大间隙，吻合前需要充分游离肾脏。
