Department of Urology,Shenzhen Longhua District Central Hospital,The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province,China.
Department of Urology, Shenzhen People's Hospital,The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong Province,China.
J Xray Sci Technol. 2021;29(1):185-196. doi: 10.3233/XST-200804.
To avoid Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cyst (diameter > 70 mm), we present two cases of iatrogenic ureteral injury and discuss their clinical courses and final outcomes.
Two male patients (47 years old and 74 years old) with large left simple renal cysts underwent a retroperitoneal laparoscopic operation to treat the cysts. In the first patient, the left proximal ureter was partially transected (Grade 3) during the operation. The injury was identified intraoperatively. The transection was managed with a primary ureteroureterostomy (end to end) along with a double J ureteral stent. In the second patient, the left proximalureter was partially transected (Grade 4). However, the injury was unrecognized postoperatively for two days. After recognition of the complication, the injury was managed with an early primary ureteroureterostomy, which followed a failed attempt to place ureteral stent endoscopically.
In the first patient, a postoperative urinary leakage developed and lasted for 13 days. During long term follow-up of the first patient after the urine leak resolved, there were no reports of pain in the lumbar region or other discomfort. No recurrence of the renal cyst occurred, which was confirmed with an ultrasound at one year postoperatively. In the second patient a ureteral fistula and severe perirenal infection occurred and lasted for 86 days. The patient ultimately underwent a left nephrectomy after conservative management for this surgical complication failed. This patient developed a chronic wound infection that lasted for 3.14 months following the nephrectomy. During follow-up post nephrectomy, the patient developed stage 3B moderate chronic kidney disease (CKD) (GFR = 30 -44 ml/min).
For single large (diameter > 70 mm) renal cysts located at the lower pole of the kidney, it is recommended to not completely dissect out and mobilize the entire renal cyst for cyst decortication in order to avoid injuring the ureter. Iatrogenic ureteral injury increases the risk of readmission and serious life-threatening complications. The immediate diagnosis and proper management ureteric injury can reduce complications and long term sequalae.
为避免后腹腔镜治疗大肾囊肿（直径＞70mm）时医源性输尿管损伤，我们报告 2 例医源性输尿管损伤病例，并讨论其临床经过和最终结局。
2 例男性患者（47 岁和 74 岁），左侧单纯性大肾囊肿，行后腹腔镜手术治疗囊肿。第 1 例患者术中发现左侧近端输尿管部分横断（3 级）。术中行输尿管端端吻合术（端端吻合）加双 J 输尿管支架管治疗。第 2 例患者左侧近端输尿管部分横断（4 级）。但术后 2 天未发现损伤。确认并发症后，行早期输尿管端端吻合术，随后内镜放置输尿管支架失败。
第 1 例患者术后出现尿漏，持续 13 天。第 1 例患者尿漏解决后长期随访，无腰部疼痛等不适。术后 1 年超声检查未见肾囊肿复发。第 2 例患者发生输尿管瘘和严重肾周感染，持续 86 天。经保守治疗无效后，该患者最终行左肾切除术。该患者在肾切除术后发生慢性伤口感染，持续 3.14 个月。肾切除术后随访时，患者发生 3B 期中度慢性肾脏病（CKD）（GFR=30-44ml/min）。
对于单个大（直径＞70mm）肾下极肾囊肿，建议不完全解剖和游离整个肾囊肿以进行囊肿剥除，以避免损伤输尿管。医源性输尿管损伤增加了再入院和严重危及生命并发症的风险。及时诊断和正确处理输尿管损伤可减少并发症和长期后遗症。
