Magnetic Resonance Imaging in Diagnosis of Complications of Renal and Ureteral Injuries in Different Periods of Traumatic Disease

The aim of this study was to evaluate the effectiveness of MRI in diagnosing combined renal and ureteral injuries at different periods of traumatic disease (TD). Methods and Results: We analyzed the results of diagnostics and treatment of 139 patients (80 women and 59 men) with renal and ureteral injuries aged between 18 and 72 years. There were 67(48.2%) patients in the period of acute reaction to trauma, 40(28.8%) patients with early manifestations, and 32(23%) patients in the period of late manifestations. In 127(91.4%) patients, an urgent plain abdominal X-ray was performed without any preliminary preparation. USI of the abdominal and retroperitoneal space was performed in 108(77.7%) patients in the stage of the primary assessment of renal injury as it was a rapid non-invasive investigation. A whole-body MSCT was performed in 131(94.2%) patients, using the nonionic contrast agents Ultravist (350mg I/ml) and Omnipaque (350mg I/ml). MRI was performed in 125(89.9%) patients, including cases of pregnancy and a medical history of allergies. Contrast-enhanced MSCT had a high diagnostic efficiency in assessing complications in kidney and ureteral injuries at different periods of TD (accuracy of 89.2% for acute reaction, 88.8% for early manifestations, and 89.5% for late manifestations). MRI of the kidneys and ureters was indicated in periods of early and late manifestations of TB to detect renal complications in cases with a discrepancy between clinical manifestations and the results obtained by ultrasound and MSCT (accuracy of 87.5% for early manifestations and 89.9% for late manifestations).

Late diagnosis of ureteral injury from anterior lumbar spine interbody fusion surgery: Case report and literature review

Background: Anterior Lumbosacral Interbody Fusion (ALIF) is a type of back surgery with the advantages of direct access to the spinal interbody space and the potential lessening morbidity related to posterior approaches. Purpose: To describe a rare case of left ureteral lesion from ALIF surgery diagnosed 4 months after the procedure. Case description: A 37-year-old Caucasian man with a long history of painful post-traumatic spondylolisthesis and degenerative L5-S1 disc disease underwent a retroperitoneal anterior L5-S1 discectomy, insertion of an interbody tantallium cage, and placement of a pyramid titanium plate fixed with screws. Four months later, due to recurrent left lumbar pain and mild renal failure, a CT scan was performed showing left hydronephrosis with a homolateral urinoma of 17 cm in diameter. A left nephrostomy was placed and the nephrostography detected a filiform leakage at L5-S1 level in communication with the urinoma. The patient underwent laparoscopic urinoma drainage, distal left ureterectomy, and Casati-Boari flap ureterocystoneostomy with ureteral double J stent placement. The stent was held for six weeks and, 1 month later, the control ultrasound scan was negative for hydronephrosis, the creatinine level had normalized and the patient was asymptomatic. Conclusion: Ureteral lesion from ALIF surgery is a very rare event. Spinal surgeons should be more awareness regarding the susceptibility of ureteral injuries along with the clinical presentation, diagnostic work-up, and management options for this kind of complication.

Etiology and Ureteral Reconstruction Strategy for Iatrogenic Ureteral Injuries: A Retrospective Single-Center Experience

Objective: To analyze the etiology, characteristics, and ureteral reconstruction strategies of iatrogenic ureteric injuries in a high-volume center. Methods: Between September 2010 and August 2019, we retrospectively collected patients who underwent ureteral reconstruction due to iatrogenic ureteric injuries. Patient profiles, laboratory data, imaging studies, perioperative data, and complications were recorded. Results: Sixty-eight patients were enrolled in this study. The upper, middle, and lower thirds of the ureter were affected in 30, 2, and 36 cases, respectively. Of the 68 ureteric injuries, 69.1% occurred during urological procedures, followed by gynecological procedures, general surgery, radiotherapy, and orthopedic surgery. The majority of urological injuries (41, 87.2%) occurred due to stone removal. There was a significant difference in the age, sex, and location of ureteric injuries between the urological and nonurological groups. The median follow-up time was 17.9 months. The overall symptom remission rate was 91.2% and ranged from 87.5 to 100% for different reconstructive surgeries. Conclusions: Urological procedures were the most common cause of iatrogenic ureteric injury; thus, extra care should be taken. Timely detection and appropriate treatment of the ureteric injuries are necessary. Treatment strategies should be depended on the location and length of injury.

WHAT IS THE EFFECT OF SMALL SIZE URETERAL ACCESS SHEAT ON URETERAL STRICTURE DURING RETROGRADE INTRARENAL SURGERY?: A ONE-YEAR FOLLOW-UP.

Aim: To analyze the ureteral injury and incidence of ureteral stricture in a series of patients who underwent retrograde intrarenal surgery with using smallest ureteral access sheath. Materials and Methods: Between September 2016 and March 2019, 154 consecutive retrograde intrarenal surgery procedures with adjunctive use of an ureteral access sheath for kidney stone were prospectively included the study. A 9.5/11.5-F ureteral access sheath was used during procedures. The patients were evaluated in terms of intraoperative postoperative and late complications. Ureteral injuries after retrograde intrarenal surgery were assessed visually with flexible and semirigid ureterorenoscope. All patients were evaluated by computed tomographic urography in the first year after treatment for detection of ureteral stricture. Results: The mean age of the patients was 47±15 (12-81) years. Of the patients, 86 were male and 68 were female. Mean stone size was 17.1±8 (7-40) mm and mean operative time was 56±23 (30-120) minutes. Overall 79.9% of patients had evidence of injury to the ureter wall. Non-significant lesion (grade 0) was seen in 39.0% of patients. Grade 1 lesions were assigned in 40.9% of patients. There were no grade 2 and higher lesions detected. A total of 5 patients (3.2%) had minor complications. Urinary sepsis developed as a major complication in 3 patients (1.9%). No ureteral stricture was detected in the patients at first year control. Conclusions: The results of our series indicate that the 9.5/11.5-F ureteral access sheath is safe for routine use to facilitate flexible ureteroscopy and there was no long-term adverse effect.

Intraoperative ureter identification with a novel fluorescent catheter

Iatrogenic ureteral injuries (IUI) occur in 0.5–1.3% of cases during abdominal surgery. If not recognized intraoperatively, IUI increase morbidity/mortality. A universally accepted method to prevent IUI is lacking. Near-infrared fluorescent imaging (NIRF), penetrating deeper than normal light within the tissue, might be useful, therefore ureter visualization combining NIRF with special dyes (i.e. IRDye 800BK) is promising. Aim of this work is to evaluate the detection of ureters using stents coated with a novel biocompatible fluorescent material (NICE: near-infrared coating of equipment), during laparoscopy. female pigs underwent placement of NICE-coated stents (NS). NIRF was performed, and fluorescence intensity (FI) was computed. Successively, 0.15 mg/kg of IRDye 800BK was administered intravenously, and FI was computed at different timepoints. Ureter visualization using NS only was further assessed in a human cadaver. Both methods allowed in vivo ureter visualization, with equal FI. However, NS were constantly visible whereas IRDye 800BK allowed visualization exclusively during the ureteral peristaltic phases. In the human cadaver, NS provided excellent ureter visualization in its natural anatomical position. NS provided continuous ureteral visualization with similar FI as the IRDye 800BK, which exclusively allowed intermittent visualization, dependent on ureteral peristalsis. NS might prove useful to visualize ureters intraoperatively, potentially preventing IUI.