Full-length ureteral avulsion caused by ureteroscopy: report of one case cured by pyeloureterostomy, greater omentum inv
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LETTER TO THE EDITOR
Full-length ureteral avulsion caused by ureteroscopy: report of one case cured by pyeloureterostomy, greater omentum investment, and ureterovesical anastomosis Peng Gao • Jin Zhu • Yibin Zhou • Yuxi Shan
Received: 8 December 2012 / Accepted: 18 December 2012 / Published online: 9 January 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract The aim of this report was to look for a good solution to full-length ureteral avulsion. This report retrospectively analyzed the data of the patient. The patient underwent ureteroscopic management. Full-length avulsion of ureter occurred during ureteroscopy. Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis were performed immediately. The patient was followed-up 25 months. After the first operation, the patient developed hydronephrosis because of press of fibrosis tissue outside ureter and anastomotic atresia of ureter-bladder. When we finished the second operation, the renal function recovered well. Fulllength avulsion of ureter is a severe complication. Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis are probably a good choice.
Introduction
Keywords Ureteral avulsion Ureterovesical anastomosis Pyeloureterostomy Greater omentum
A 48-year-old man was admitted to our hospital with left renal colic. Intravenous pyelography and ultrasonography of urinary system revealed a calculus measuring 8 9 8 mm located in the left upper ureter. The patient underwent ureteroscopic treatment using a 9.5 F storz semirigid ureteroscope. Full-length avulsion of ureter occurred during the operation. The avulsed ureter was pulled out of body and put into physiological saline. The reconstruction treatment choice was a decision made by the patient after extensive discussion with members of the Second Affiliated Hospital of Soochow University Urology Center team. The patient was diagnosed with left upper ureteral stone. Transurethral ureterolithotripsy was performed with 9.5 F storz semirigid ureteroscope. A safety guide wire was inserted into the left ureter. The scope was advanced over the guide wire without dilation of the orifice. A litter ‘‘tight’’ sensation was felt inside distal ureter. Some pressure was needed to move the scope. The ureteroscope was
P. Gao J. Zhu Y. Zhou Y. Shan (&) Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China e-mail: [email protected] P. Gao e-mail: [email protected] J. Zhu e-mail: [email protected] Y. Zhou e-mail: [email protected]
Urolithiasis has played an important role in the list of urinary disease. We should pay more attention to ureteral stone due to its high incidence, complications, and frequency of recurrence. With the development of technology, we can choose different treatments. The semirigid ureteroscope is a good, familiar treatment of ureteral stone, which can provide excellent irrigation flow and visualization. Ureteral avulsion is a rare but seriou
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