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Vascular surgery-associated ureteral injury: zebras do exist
M C Dalsing1, R Bihrle, S G Lalka
1Department of Surgery, Indiana University Medical Center, Indianapolis.
Annals of Vascular Surgery
|March 1, 1993
Summary
Direct ureteral injury during vascular surgery is rare but often missed, leading to delayed diagnosis and treatment. This case highlights a unique ileal conduit repair for renal salvage, achieving long-term success without infection.
Area of Science:
- Urology
- Vascular Surgery
- Surgical Complications
Background:
- Direct ureteral injury is a rare complication of retroperitoneal vascular surgery.
- Redo surgeries present a higher risk for ureteral injury.
- Delayed diagnosis is common due to varied presentations.
Observation:
- The patient sustained a direct ureteral injury during retroperitoneal vascular surgery.
- Diagnosis was delayed, and treatment was complicated by infection.
- A literature review indicated ureteral contrast studies are crucial for diagnosis.
Findings:
- Ureteral injuries during vascular surgery are frequently missed, with delays potentially lasting months.
- Standard treatments for delayed injury include ureteroureterostomy or nephrectomy.
- This case successfully utilized an ileal conduit for ureteral replacement, preserving renal function.
Implications:
- An aggressive approach to renal salvage is feasible in otherwise healthy patients.
- Ileal conduit replacement offers a unique solution for severe ureteral damage in this context.
- Management of associated infection is critical, with graft removal potentially necessary.