URETERAL INJURY DURING RADICAL ORTHOPEDIC CANCER SURGERY

Abstract

Case 1. A 34-year-old man presented to the orthopedic department with low back pain and sciatica on the right side. X-ray and magnetic resonance imaging (MRI) showed a large mass involving the right hemipelvis and biopsy confirmed osteosarcoma (see figure). The ureters were not specifically imaged with contrast material, and staging investigations revealed no evidence of metastases. Thus, the patient underwent right hindquarter amputation, including tumor dissection near the bladder. An immediate postoperative urine leak from the wound occurred and contrast studies confirmed extravasation near the vesicoureteral junction. Nephrostomy was placed but the wound became infected and required exploration. The distal ureter was visualized by the urologist during this procedure and appeared ischemic. Thus, it was successfully reimplanted using a Boari flap. Case 2. A 33-year-old man presented with chronic right upper thigh pain to the orthopedic surgery department. X-ray and MRI suggested a proximal femoral mass, which was biopsied and confirmed as osteosarcoma. The ureters were not specifically imaged with contrast material and staging investigations suggested localized tumor. Thus, a right hindquarter amputation was performed. The right ureter was transected during the procedure. The distal segment was tied off, and a ureteral catheter was placed in the proximal segment and delivered from the right lateral aspect of the wound. Urine was leaking from the wound site 3 days later. A retrograde contrast study demonstrated a completely displaced stent. A subsequent ultrasound showed a hydronephrotic system and therefore nephrostomy was placed. The ureter was successfully reimplanted using a Boari flap the following day.