Blitz Sarah Elizabeth, Chua Melissa Ming Jie, Klinger Neil Vernon, Chi John H
Harvard Medical School, Boston, Massachusetts, Boston, United States.
Department of Neurosurgery, Brigham and Women's Hospital, Boston, United States.
Surg Neurol Int. 2022 Jul 1;13:279. doi: 10.25259/SNI_479_2022. eCollection 2022.
Ureteral fistulas are abnormal connections between the ureters and other organs. Maintaining a high index of suspicion is important because they can precipitate dangerous complications such as sepsis and renal failure. Connections to a vertebral body have only been documented in the setting of trauma. Here, we present a 67-year-old female with a ureterovertebral fistula extending into the L3 vertebral body.
A 67-year-old female with a history of endometrial adenocarcinoma underwent surgery and radiation therapy complicated by a right ureteral obstruction requiring stent placement. Five months later, she developed back pain and MR-documented L2-L4 level osteomyelitis/discitis with a psoas phlegmon/abscess, which required drainage. A fistula was later identified between the right ureter and the psoas phlegmon. Despite percutaneous nephrostomy placement and aggressive IV antibiotic treatment, she was readmitted for persistent signs of infection over the next few months during which time she was repeatedly and unsuccessfully treated with multiple antibiotics. Sixteen months following her original stent placement, she developed right leg weakness and urinary incontinence attributed to the MR-documented ureteropsoas fistula extending into the L3 vertebral body. Following a nephrectomy with ureteral ligation, an L3 anterior corpectomy with interbody fusion for discitis at both L2-L3 and L3-L4, and an L1-L5 posterolateral fusion, she was discharged to a rehabilitation center.
In patients with recurrent sepsis, osteomyelitis/discitis, or psoas abscess of unknown origin or who have a significant history (e.g., pelvic malignancy, radiation, and instrumentation), it is important to consider urodynamic testing to look for a ureteral leak or fistula.
输尿管瘘是输尿管与其他器官之间的异常连接。保持高度怀疑指数很重要，因为它们可能引发败血症和肾衰竭等危险并发症。与椎体的连接仅在创伤情况下有记录。在此，我们报告一名67岁女性，患有延伸至L3椎体的输尿管椎体瘘。
一名有子宫内膜腺癌病史的67岁女性接受了手术和放疗，术后并发右输尿管梗阻，需要放置支架。五个月后，她出现背痛，磁共振成像显示L2-L4水平有骨髓炎/椎间盘炎，并伴有腰大肌脓肿，需要引流。后来发现右输尿管与腰大肌脓肿之间存在瘘管。尽管进行了经皮肾造瘘术并积极静脉使用抗生素治疗，但在接下来的几个月里，她因持续的感染迹象再次入院，在此期间，她多次接受多种抗生素治疗，但均未成功。在最初放置支架16个月后，她出现右腿无力和尿失禁，磁共振成像显示输尿管腰大肌瘘延伸至L3椎体。在进行肾切除术并结扎输尿管、对L2-L3和L3-L4椎间盘炎进行L3前路椎体次全切除并椎间融合以及L1-L5后外侧融合后，她出院前往康复中心。
对于患有复发性败血症、不明原因的骨髓炎/椎间盘炎或腰大肌脓肿的患者，或有重大病史（如盆腔恶性肿瘤、放疗和器械操作）的患者，考虑进行尿动力学检查以寻找输尿管漏或瘘很重要。
