ureter injury during posterior lumbar disc surgery

Major vascular injuries during lumbar disc surgery are rare but well-recognized complications. However, vascular injuries of the branches of the aorta and ureteral injuries are very rare. Although its incidence is not known definitely, it is estimated to be 1/1000. Ureteral injuries comprise less than 1% of all genitourinary traumas. In this article, we report clinical progress of a patient who had simultaneous internal iliac artery and ureteral injury during lumbar discectomy. The patient was managed with primary ureteroureterostomy. To our knowledge, this is the first case reported with simultaneous ureter and iliac artery trauma during lumbar disc surgery

"AZ" technique

Introduction and hypothesis To present the surgical details and the outcomes of our modified ventral onlay buccal mucosal graft (BMG) urethroplasty technique in female patients with urethral strictures. Methods We included the first seven female patients who had BMG urethroplasty between January 2015 and April 2019 and had at least 6 months of follow-up. Patient age, stricture length, comorbidities, number of previous treatments, pre- and postoperative uroflowmetry data, and post-void residual volumes were recorded. Results The mean patient age was 56.7 (44-80) years. The mean stricture length was 3.1 (2-4) cm. The mean postoperative follow-up time was 23 (7-48) months. The preoperative mean maximal flow rate (Qmax) was 5.1 (3.2-9.5) ml/s and post-void residual urine volume (PVR) was 84.4 (37-158) ml. At the 3rd month after surgery, mean Qmax was 31.8 (24.7-36.2) ml/s, and PVR volume was 7.1 (0-16) ml. Three patients had the postoperative 2-year follow-up, and 12th and 24th month mean Qmax values were 28 (23.6-33.2) ml/s and 28.5 (24.1-31.1) ml/s, respectively. The mean operation time was 63.8 (55-113) min. We did not observe any infection, vaginal erosion, urinary incontinence, or oral discomfort due to graft harvesting postoperatively. Conclusion Female urethroplasty provides high cure rates and should be performed in case of recurrent FUS. The early and medium-term results of our modified new technique indicated that it might be used as a simple alternative to current techniques. In all of our patients, it significantly increased the flow rate and reduced PVR without any significant complications.C1 [Ozlulerden, Yusuf; Celen, Sinan; Zumrutbas, Ali Ersin; Aybek, Zafer] Pamukkale Univ, Sch Med, Dept Urol, Denizli, Turkey.[Aybek, Zafer] Pamukkale Univ, Tip Fak, Urol Anabilim Dali, Denizli, Turkey

Posterior nutcracker syndrome: caused by pelvic pain

Posterior nutcracker syndrome is one of the abdominal venous entrapments caused by compression of the left renal vein between the vertebral column and the abdominal aorta. In this article, we report our first experience in a patient with posterior nutcracker syndrome who was referred to our clinic with pelvic congestion symptoms. A 39-year-old female patient was admitted to our clinic with the complaint of pelvic pain especially on the left side. Abdominal computed tomography angiography demonstrated vascular congestion appearance extending from pelvis at retroperitoneal space On the left side. End-to-side gonadocaval bypass was performed to the patient. Postoperative abdominopelvic tomography revealed that perirenal and retroperitoneal hematoma resolved completely. All of her previous complaints disappeared in the second postoperative months. We believe that gonadocaval bypass is an open surgical procedure which can be safely performed for selected patients