Laparoscopic ureteral repair for iatrogenic ureteral injury following lumbar disc surgery

SummaryIatrogenic ureteral injury is a rare yet severe complication in lumbar disc surgery. In our hospital we encountered only one such incident in 1946 prior to this case. We hereby present a novel approach in which laparoscopic end-to-end ureteral anastomosis was adopted for the repair of ureteral injury after lumbar disc surgery. A 60-year-old female underwent minimal invasive transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis of the L4–5 level in 2012. Two days after the surgery, the patient complained of progressive right flank pain and a persistent lack of stool passage. An abdominal computer tomography showed right retroperitoneal urinoma and injury to the proximal ureter, which was revealed by contrast extravasation. Retrograde ureteroscopy confirmed complete avulsion of the ureter. Using a double-J catheter as the stent, we laparoscopically repaired the severed ureter, using the end-to-end anastomosis method. Although the operation lasted for 180 minutes, the estimated blood loss was only approximately 50 mL. The double-J catheter was removed 1 month after the surgery. Commonly encountered urological complications, such as obstructive uropathy, loss of renal function, or the subjective flank pain did not occur in the 6-month follow-up. Although the probability of occurrence is low, however, TLIF surgery is potentially capable of causing ureteral injury. The key to the successful execution of safe spinal surgery with a significant risk of ureteral damage would be the careful use of a curette instead of a rongeur. However, in the unforeseen situation where the ureteral damage has occurred, laparoscopic ureteral repair would be an option that could result in a good surgical outcome.