Renal Autotransplantation for Complete Ureteral Avulsion Following Dilation and Curettage: A Rare Iatrogenic Complication

Abstract

Background: Renal autotransplantation is a rare yet effective surgical strategy for managing complex ureteral injuries when conventional reconstructive options are not viable. We report an exceptional case of complete ureteral avulsion following a dilation and curettage (D&C) procedure, successfully treated with renal autotransplantation. This represents the first documented case of renal autotransplantation in Yemen, highlighting a successful organ-preserving approach in a resource-limited setting.

Case presentation: A 34-year-old female developed life-threatening complications following a D&C performed for retained products of conception. The procedure was complicated by uterine perforation and a complete avulsion of the left ureter, which was identified intraoperatively during emergent laparotomy. Initial management included pyelostomy, which failed, necessitating nephrostomy. Because to the absence of a viable ureteral stump, renal autotransplantation was performed. The kidney was reimplanted into the right iliac fossa, and urinary continuity was restored via a Boari flap. The patient had an uneventful postoperative course and demonstrated preserved renal function at two-month follow-up.

Conclusion: Complete ureteral avulsion is an exceedingly rare complication of D&C, often linked with uterine perforation. In cases where standard ureteral reconstruction is not feasible, renal autotransplantation provides a definitive, nephron-sparing solution. Early identification and referral to experienced centers are essential to optimizing outcomes.

Keywords: Boari flap; dilation and curettage; iatrogenic ureteral injury; renal autotransplantation; ureteral avulsion.

Figure 1

(a) Intraoperative image showing the explanted left kidney following nephrectomy and perfusion with cold heparinized saline solution prior to autotransplantation. (b) Restoration of blood flow in the transplanted kidney immediately after vascular anastomosis to the external iliac artery and vein in the right iliac fossa. (c) Construction of the Boari flap from the anterior bladder wall, formed into a tube to bridge the gap between the renal pelvis and urinary bladder.