<p>Complete ureter avulsion causing a long defect as a complication of posterior spine fusion: a rare case treated with nonrobotic laparoscopic repair</p>

Abstract

PurposeUreter avulsion, a challenging urologic complication, has been rarely found in lumbar spine surgeries. Once ignored, the leaked urine usually leads to significant morbidity and also makes further repair more difficult. We present an unusual ureter injury causing a long defect which occurred in posterior spine fusion; immediate repair was performed with minimal invasion.Case presentationA 61-year-old female was receiving microscopic spine fusion (transforaminal lumbar interbody fusion) for her L3–L5 spondylosis. Ureter avulsion with one 3-cm defect occurred unexpectedly. We confirmed urine extravasation promptly, and performed end-to-end ureteroureterostomy with laparoscopy. Retrograde double-J stenting was indwelled. Her postoperative condition was uneventful.ConclusionThis rare case with good outcome highlights the importance of early diagnosis and immediate repair for complete ureter avulsion. We prove that reanastomosis for ureter loss as much as 3 cm is feasible with laparoscopy in regional hospitals where a robot is not available. To deal with large gaps between stumps, adequate kidney mobilization is required before anastomosis.

Fracture of the Lumbar Spine Associated with Ureteral Injury Mimicking Spondylodiscitis Followed by Cervical Spine Fracture in Patient with Ankylosing Hyperostosis

“…In this case, different management options can be considered depending on the level of injury and its nature. Nevertheless, even with a far-reaching injury, ureter injury does not reveal notable symptoms initially, and its diagnosis is usually delayed [14]. Unfortunately, after 2 years of recovery, this same patient presented again with an unstable three-column fracture at the C5/C6 level and tetraparesis.…”