Transplant Surgeon Nicks Patient’s Ureter Causing Kidney Failure

This case involves a forty-six-year-old female patient who was diagnosed with ovarian and kidney cancer after having used adult baby powder consistently for the past seven years. Surgery was performed to remove the renal mass and the malignant ovaries. During the surgery, the physician mistakenly nicked the patient’s ureter and this condition went unrecognized and untreated. Three months later, the patient presented to the emergency room complaining of lethargy and the inability to urinate for several days. The ureteral damage was finally uncovered and the patient underwent a corrective surgery to repair the damage. Soon after the procedure, the patient went into acute renal failure and the remaining kidney was determined to be nonfunctional. The patient was promptly placed on peritoneal dialysis and required a kidney transplant. The patient benefited from a living donor transplantation but sustained significant emotional damages as a result of the near-death experience.

Question(s) For Expert Witness

1. How should ureteral damage be managed in a patient with acute renal failure?

Expert Witness Response E-000413

Management of ureteral injuries is dictated by the location, type, extent, timing of presentation, medical history, and overall status of the patient, including associated injuries and prognosis. Ureteral injuries in patients who are too unstable to tolerate surgery should be repaired in a staged fashion or, extremely rarely, with nephrectomy. If a staged repair is chosen, the damaged ureter is initially tied off with long silk ties to aid in visualization of the ureter during the second stage of the repair. The kidney is drained percutaneously, preferably in the immediate postoperative period by the surgeon, or later by the interventional radiologist. Some surgeons have placed an 8F feeding tube into the ureter and exteriorized it until the repair could be completed. Although nephrectomy is rarely necessary, it may be indicated in cases of severe collateral and irreparable injury to the ipsilateral kidney or a severe pan ureteral injury. Even the most devastating ureteral injuries, however, can usually be repaired with reconstruction.