Ureteral injury associated with anterior lumbosacral arthrodesis in a patient who had crossed renal ectopia, malrotation, and fusion of the kidneys. A case report.

The ureter is frequently injured during difficult abdominal or pelvic operations when the normal anatomy has been changed. It may also be injured when an ectopic kidney has altered the expected course of the ureter. Ureteral injury is a rare complication of operations on lumbar discs, and only a few cases of ureteral injury during lumbar laminectomy through a posterior approach have been described1. In a search of the English-language literature, we found no case reports in which an injury of the ureter was associated with an anterior lumbosacral arthrodesis in a patient who had crossed renal ectopia with fusion and malrotation of the kidneys. We report the case of a patient who had such an injury in order to alert the reader to this rare cause of intraoperative injury of the ureter and to describe the successful treatment of this complication. A forty-four-year-old woman who had had episodes of severe, chronic low-back pain for nineteen years was referred to one of us (D. M. W.), an orthopaedic surgeon, by her neurologist in 1988. She had had numerous evaluations and operations, including an appendectomy in 1953, an abdominal hysterectomy in 1982, and an excision of the most distal part of the os coecygis in 1984, without relief of the symptoms. In 1979, she had also reported dysuria, frequency of urination, nocturia, recurrent infection of the urinary tract, and constipation. In 1986, a urologist …