A case of iatrogenic ureteric injury presenting with headache

A 33-year-old woman was referred to the renal outpatient clinic with a headache caused by severe hypertension. She had given birth 3 months previously by emergency caesarean section after a labor complicated by uterine rupture. She had delivered by caesarean section twice previously.

Full blood count, urinalysis, serum creatinine level, renal ultrasonography, antegrade and retrograde studies.

Renal ultrasonography showed marked left hydronephrosis. Antegrade and retrograde studies showed a short ureteric stricture 3 cm proximal to the vesicoureteric junction causing complete obstruction and consistent with iatrogenic ureteric injury.

A left nephrostomy was placed and the patient was treated with nifedipine and prazosin. Her hypertension resolved and these drugs were discontinued 1 week later. The ureteric stricture was managed by entirely endourological means. A guidewire was manipulated across the stricture via a combined antegrade and retrograde approach. Ureterotomy was then undertaken using a holmium yttrium-aluminum-garnet laser, followed by placement of a endopyelotomy stent with the larger segment across the stricture site. A good result was seen at ureteroscopy following subsequent stent removal. The patient remains normotensive.