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A case of iatrogenic ureteric injury presenting with headache

Nature Clinical Practice Urology volume 5, pages 113–116 (2008)Cite this article

Abstract

Background 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.

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

Diagnosis 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.

Management 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.

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Figure 1: Nephrostogram of the distal left ureter showing the region of obstruction (posteroanterior film).
Figure 2: Distal left ureter observed on retrograde contrast fluoroscopy.
Figure 3: Fluoroscopic image showing the passage of the ureteroscope proximal to the stricture.
Figure 4: Fluoroscopic image showing the endopyelotomy stent in position.
Figure 5: Ureteroscopic images of the site of the treated stricture following stent removal.

References

  1. Selzman AA and Spirnak JP (1996) Iatrogenic ureteral injuries: a 20-year experience in treating 165 injuries. J Urol 155: 878–881

    Article  CAS  Google Scholar 

  2. Silver RM et al. (2006) Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 107: 1226–1232

    Article  Google Scholar 

  3. Ishidoya S et al. (2000) Chronic unilateral ureteral obstruction represented as renin-dependent hypertension. Nephron 85: 175–177

    Article  CAS  Google Scholar 

  4. Varon J and Marik PE (2000) The diagnosis and management of hypertensive crises. Chest 118: 214–227

    Article  CAS  Google Scholar 

  5. Gulmi FA et al. (2002) Pathophysiology of Urinary Tract Obstruction. In Campbell's Urology, edn 2 411–462 (Eds Walsh PC et al.) Philadelphia: Saunders

    Google Scholar 

  6. Vaughan ED Jr et al. (1970) Peripheral renin and blood pressure changes following complete unilateral ureteral occlusion. J Urol 104: 89–92

    Article  Google Scholar 

  7. Pimentel JL Jr et al. (1993) Regulation of renin-angiotensin system in unilateral ureteral obstruction. Kidney Int 44: 390–400

    Article  CAS  Google Scholar 

  8. Frøkiaer J et al. (1992) The impact of total unilateral ureteral obstruction on intrarenal angiotensin II production in the polycalyceal pig kidney. Scand J Urol Nephrol 26: 289–295

    Article  Google Scholar 

  9. Fukuzaki A et al. (1993) Role of glomerular eicosanoid production in the obstructed kidney. Int Urol Nephrol 25: 525–531

    CAS  PubMed  Google Scholar 

  10. Shapiro SR and Bennett AH (1976) Recovery of renal function after prolonged unilateral ureteral obstruction. J Urol 115: 136–140

    Article  CAS  Google Scholar 

  11. Hibi H et al. (2001) Endoscopic ureteral incision using the holmium:YAG laser. Int J Urol 8: 657–661

    Article  CAS  Google Scholar 

  12. Hong JH et al. (2005) Result of endoscopic ureteroureterostomy with holmium:YAG laser for complete ureteral obstruction. J Endourol 19: 979–983

    Article  Google Scholar 

  13. Razdan S et al. (2005) Ureteroscopic endoureterotomy. BJU Int 95 (Suppl 2): 94–101

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. where MA Roder is a medical student in the Department of Urology and P Aslan and W Lynch are Urological Surgeons. M Brown is Professor of Renal Medicine at the University of New South Wales and the St George Private and Public Hospitals in Sydney, S Phipps is the Endourology Fellow at the St George Private and Public Hospitals, Australia.,

    Simon Phipps, Martin A Roder, Peter Aslan, Mark Brown & William Lynch

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  1. Simon Phipps
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  2. Martin A Roder
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  3. Peter Aslan
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  4. Mark Brown
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  5. William Lynch
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Correspondence to Simon Phipps.

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The authors declare no competing financial interests.

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Phipps, S., Roder, M., Aslan, P. et al. A case of iatrogenic ureteric injury presenting with headache. Nat Rev Urol 5, 113–116 (2008). https://doi.org/10.1038/ncpuro0998

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