J Korean Neurosurg Soc.  2023 Sep;66(5):605-608. 10.3340/jkns.2023.0148.

Letter to the Editor : Classifying the Anatomical Location of the Ureter after Retroperitoneal Dissection

• Lee SH
• Son DW
• Lee JS
• Song GS

• KMID: 2545352
• DOI: http://doi.org/10.3340/jkns.2023.0148

Figure

• 

  Fig. 1. Schematic location of the ureter on a dual-phase computed tomography scan. A : On the psoas (red circle), above the psoas (yellow circle), beside the psoas muscle (blue circle), retroperitoneal dissection plane (red dotted line). B : The ureter located above the psoas (yellow circle); after retroperitoneal dissection, the ureter can be easily retracted medially, retractor (blue). C : The ureter located on the psoas (red circle); after retroperitoneal dissection, the ureter can be easily visible and retracted medially (red arrow). D : The ureter is beside the psoas (blue circle); it is not identified even after conventional retroperitoneal dissection. E : The ureter can be injured by blindly fixing the retractor pinning (red arrow), or (F) blindly retracting the ureter laterally and injuring it during pull-out trials (green).

• 

  Fig. 2. Ureter under the psoas muscle. A and B : Preoperative dual phase computed tomography image (A : artery phase). The ureter (yellow arrow) cannot be distinguished from the psoas muscle, the retroperitoneal dissection plane is expected as a red dotted line (B : ureter phase). The left ureter (yellow arrow) hidden under the psoas muscle is contrast enhanced. To prevent ureter damage, identifying the ureter and medial retraction is necessary as the blue dotted line, (C) postoperative 1 week magnetic resonance imaging, left iliac vein and ureter and some visceral vessel was moved medially, white dotted line indicate the real dissection plane. Blue area : inferior vena cava, red area : left iliac artery, yellow circle : ureter.

Reference

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