泌尿內視鏡治療於腹部主動脈瘤手術後之輸尿管損傷 --- 病例報告與文獻回顧
林志德、張博誌、謝明里、黃世聰、陳煜、黃信介、許毓昭、李威昌
林口長庚紀念醫院 外科部 泌尿科
Endourological management of iatrogenic ureter injury after abdominal aortic aneurysm surgery: report of 2 cases and literature review
CHIH-TE LIN、Po-Chih Chang、Ming-Li Hsieh、Shih-Tsung Huang、Yu Chen、
Hsin-Chieh Huang、Yu-Chao Hsu、Wei-Chang Li
Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
Introduction
Acute ureteral injury results from external trauma, open surgery, laparoscopy, and endoscopic procedures
Urinoma, abscess, ureteral stricture, urinary fistula, and potential loss of an ipsilateral renal unit were complication of ureter injury. The incidence of ureteral injury varies between 0.5% and 10% . The iatrogenic cause were hysterectomy (54%), colorectal surgery (14%), other pelvic procedures like ovarian tumor removal (8%), transabdominal urethropexy (8%), and abdominal vascular surgery (6%). Endovascular stent grafts for the acute treatment was successful since 1996.
Case report
Here, we report 2 rare cases of iatrogenic ureteric injury after abdominal aortic surgery. One had underwent endovascular aneurysm repair (EVAR) and subsequent retroperitoneal exploration due to abscess formation and the other resection of the distal aortic and left common iliac artery aneurysm with Goretex graft reconstruction. Persistent urine leak was noted from the drainage tube and IVP revealed upper ureteral obstruction and hydronephrosis in both cases. Iatrogenic ureteric injuries were impressed. We successfully made the ureteral realignment with retrograde ureteroscope and antegrade double-J stenting respectively. No urine leakage and ureteral obstruction were found after the procedure.
Conclusion
These are cases of ureteral injury after vascular surgery, which image showed extravasation in ureteral lesion or hydronephrosis. The initial treatment might be considered percutaneous nephrostomy if renal function deterioration. The definitive treatment should be considered endoscopic surgery, radiologic stenting, or open surgery.