對側輸尿管損傷：上泌尿道泌尿上皮癌患者接受腎臟輸尿管切除手術之罕見併發症

林冠廷¹、何岩¹、林克勳^1,2、許軒豪^1,2

¹臺北市立萬芳醫院─委託臺北醫學大學辦理 泌尿科；²臺北醫學大學 醫學院 醫學系 泌尿學科

Contralateral Ureteral Injury: An Unusual Complication of Nephroureterectomy in Upper Tract Urothelial Carcinoma

Kuan-Ting Lin¹, Yen Ho¹, Ke-Hsun Lin^1,2, Syuan-Hao Syu^1,2

Department of Urology, Wan Fang Hospital, Taipei Medical University¹; Department of Urology, School of Medicine, College of Medicine, Taipei Medical University²

Background: Robotic-assisted laparoscopic nephroureterectomy is a common surgical approach for upper tract urothelial carcinoma. However, contralateral ureteral injury during bladder cuff excision is exceptionally rare and underreported.

Case Presentation: A 56-year-old man with low-grade, non-invasive papillary urothelial carcinoma of the right renal pelvis presented with right lower quadrant pain and a sensation of fullness lasting for one month. Imaging revealed a renal pelvic mass with hydronephrosis, and biopsy confirmed the diagnosis. The patient subsequently consented to robotic-assisted laparoscopic right nephroureterectomy with bladder cuff excision. During the surgery, an empty bladder was manipulated into the abdominal cavity to aid in excision, which distorted the anatomy. This created the appearance of a tubal structure, presumed to be the bladder cuff, prompting excision at a low level. Postoperatively, the patient developed anuria. Renal ultrasonography and CT imaging revealed left hydronephrosis and a surgical clip mistakenly placed at the left ureterovesical junction, obstructing the contralateral ureter. The patient underwent urgent cystoscopy and left ureteroneocystostomy with Double-J stent placement to restore ureteral continuity. Following intervention, his renal function improved steadily. By discharge, his urine output and renal function had normalized, with arrangements for follow-up to monitor both his recovery and oncologic status.

Discussion: Contralateral ureteral injury during bladder cuff excision in robotic-assisted nephroureterectomy is exceedingly rare, with few documented cases in the literature. Most studies and technical guidelines on nephroureterectomy focus on ipsilateral ureteral excision and bladder cuff management, aiming to prevent complications such as incomplete resection or tumor spillage. While innovations like extravesical stapling or Hem-o-lock hemostatic clips have improved surgical precision, these techniques can carry risk in anatomically distorted cases, as seen when a mobilized bladder resembles a tubular structure. Robotic systems enhance visualization, yet careful dissection and consistent anatomical verification are essential to avoid inadvertently injuring contralateral structures. This case underscores the critical need for thorough intraoperative verification, especially when handling the bladder cuff. Preoperative planning and heightened intraoperative awareness of potential anatomical variations may help mitigate similar complications and inform best practices in robotic nephroureterectomy.

Conclusion: This case highlights the importance of rigorous anatomical verification and preoperative planning to prevent rare contralateral ureteral injuries during robotic bladder cuff excision. Such vigilance is essential to ensure safe surgical outcomes in complex urologic oncology cases.