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TheScientificWorldJOURNAL
Volume 10, Pages 1707-1713
http://dx.doi.org/10.1100/tsw.2010.161
Case Study

Ureteral Obstruction by the Vas Deferens after Urostomy

1Regional Spinal Injuries Centre, District General Hospital, Southport, Merseyside, UK
2Department of Radiology, District General Hospital, Southport, Merseyside, UK
3Department of Urology, District General Hospital, Southport, Merseyside, UK

Received 29 April 2010; Revised 20 July 2010; Accepted 22 July 2010

Academic Editor: Anthony Atala

Copyright © 2010 Subramanian Vaidyanathan et al.

Abstract

A male patient with spina bifida and paraplegia, born in 1968, underwent urostomy in 1973. In 1999, he developed urine infections. Intravenous urography showed bilateral hydronephrosis and hydroureter. This patient continued to get recurrent urine infections. In 2009, computed tomography of the abdomen revealed dilatation of the ureters, but the ureters reverted to normal calibre as they passed forward through the anterior abdominal wall. The vas deferens on either side was crossing and kinking the ureter. Magnetic resonance imaging of the abdomen confirmed that the level of obstruction in both ureters was at the site where the vas deferens crossed the ureter and kinked it. While performing urostomy, the ureters below the crossover by the vas deferens were detached from the bladder and attached to the skin for urinary diversion, thus causing the vas deferens to hook the lower end of the ureters. As the patient gained height and weight, thereby increasing abdominal girth, kinking of the ureters by the vas deferens was accentuated. In hindsight, bilateral midline cutaneous urostomy using the ureters below the crossover by the vas deferens represents a poor surgical technique for urinary diversion.