Conservative Management of Ureteral Injury Caused by a Lumbar Osteophyte

Max Fuller,Michael Brekhus

doi:10.1089/cren.2016.0126

Abstract

Background: Osteophytes are bony outgrowths commonly found on lumbar vertebrae. They rarely produce complications with the most common complication being nerve entrapment, but rarer complications including aorta or inferior vena cava rupture, superior mesenteric artery syndrome, compression of the iliopsoas muscle, and cerebrospinal fluid leaks have been described. Rare cases affecting the ureter resulting in ureteral colic or extravasation of urine have been described.Case Presentation: We describe a case in which a lumbar osteophyte bridging the L4 and L5 disks was encircling the ureter and minor trauma caused a ureteral injury, resulting in urine extravasation into the L4 and L5 disks space and the retroperitoneum. Owing to the comorbidities of this patient, this case was treated conservatively with stenting and the patient has suffered no further complications.Conclusion: This is a rare complication of a lumbar osteophyte but should be considered as a potential cause of ureter injury. Treatment should be individualized by patient preference and comorbidities, as some patients would elect to pursue more aggressive therapy whereas others would incline for conservative measures.

Highlights

Introduction and BackgroundOsteophytes extending from lumbar vertebrae are a common incidental radiologic finding especially with increasing age
Case Presentation: We describe a case in which a lumbar osteophyte bridging the L4 and L5 disks was encircling the ureter and minor trauma caused a ureteral injury, resulting in urine extravasation into the L4 and L5 disks space and the retroperitoneum
Owing to the comorbidities of this patient, this case was treated conservatively with stenting and the patient has suffered no further complications. This is a rare complication of a lumbar osteophyte but should be considered as a potential cause of ureter injury

Summary

Introduction and Background

Osteophytes extending from lumbar vertebrae are a common incidental radiologic finding especially with increasing age. Some of the more rare complications that have been reported include aorta or inferior vena cava (IVC) rupture, superior mesenteric artery syndrome, compression of the iliopsoas muscle, and cerebrospinal fluid leaks.[1] There have been rare complications of osteophytes affecting the ureters, causing ureteral colic because of obstruction and urine extravasation of urine, and these cases have been repaired surgically with end to end anastomosis.[2,3] Ureteral injuries resulting in extravasation are exceedingly rare with most common injuries caused iatrogenically during gynecologic or abdominal surgery or from penetrating trauma These are generally repaired surgically, either open or laproscopically. Despite this stricture, she has not developed any further problems related to her injury and she continues to be followed with serial stent exchanges

Discussion and Literature

Conclusion