We report a case of bladder outflow obstruction presenting with upper tract dilatation mistaken initially as pelviureteric junction (PUJ) obstruction. The lower tract obstruction ought to be dealt with first before upper tract obstruction is assessed because the renal pelvic pressure is significantly affected by vesical filling and high bladder pressure.
This case report illustrates how a life-threatening renal bleeding which has failed to be controlled by open surgery can be elegantly managed by a minimally invasive technique of interventional radiology. It also allows maximal conservation of renal tissue so that the patient can avoid chronic dialysis or renal transplantation.
Damage to the lower ureters during pelvic surgery is a serious and well-recognised complication. This iatrogenic injury, when undetected intra-operatively, continues to give rise to significant patient morbidity. In 1987, this Department was referred 18 cases of iatrogenic ureteric injuries. 16 patients were from gynaecologic surgery and 2 patients were from general surgery. Only 4 cases (24%) were detected and referred intra-operatively. 13 patients presented post-operatively with various symptoms viz., anuria, loin pain and urinary leak per vagina. Good recovery of urinary function was achieved in all cases after urological intervention, usually by ureteric re-implantation.