PICTORIAL Cystic Retroperitoneal Mass Due to Ureteral Injury as an Outcome of Lumbar Disc Hernia Operation Süha Akpinar,1 Güliz Yilmaz,1* Emre Çelebioğlu2 Retroperitoneal organ injury, especially ureteral injury, is a rare complication associated with surgical repair of lumbar disc hernia (LDH).(1-3) A 44-year-old male patient was admitted to the urology department with a history of left flank pain, fever, and intermittent hematuria. He had a history of repeat surgical repair of an LDH at the same level 1 month previously. Ultrasound examination revealed a multiloculated cystic mass anterior to the psoas muscle, and abdominal computed tomography scan showed grade 1 hydronephrosis with proximal ureteral dilatation and free fluid in the pelvis (Figure 1A and B). A 10 French (F) pigtail ureteral drainage catheter was percutaneously inserted into the cystic mass under ultrasound guidance with a prediagnosis of abscess or urinoma (Figure 2). Owing to continuous urine drainage, antegrade pyelography was performed at the time of fluoroscopy and revealed ureteral discontinuity and extravasation of contrast material (Figure 3). Therefore, a 10 F nephrosto- Figure 1. Axial computed tomography scan of the abdomen. (A) A ret- roperitoneal multiloculated cystic mass is indenting the left psoas muscle (thick arrow), and lateroconal fascial thickening is present (thin arrow). (B) Grade 1 hydronephrosis (thick black arrow), posterior perirenal fluid (white arrow), and a cystic mass anterior to the left psoas muscle (thin black arrow) are evident. Figure 2. Axial computed tomography scan of the abdomen. A 10 French pigtail ureteral catheter is draining the giant urinoma (arrow). Figure 3. Antegrade pyelography. Mid-ureteral discontinuity (thin arrow), contrast material extravasation distal to the ureteral avulsion (thick arrow), and insertion of the pigtail catheter into the retroperitoneal urinoma (arrow- head) are shown. 1 Department of Radiology, Faculty of Medicine, Near East University, Nicosia, North Cyprus, Turkey. 2 Department of Radiology, Burhan Nalbantoğlu State Hospital, Nicosia, North Cyprus, Turkey. *Correspondence: Department of Radiology, Faculty of Medicine, Near East University, Nicosia, North Cyprus, Turkey. Tel: +90 392 6751000. Fax: +90 392 6751090. E-mail: glz.yilmaz@hotmail.com. Received December 2014 & Accepted June 2015 Pictorial 2291 my catheter was placed in the collecting system of the left kidney to control the extravasation of urine. End- to-end ureteroureterostomy was followed by double J ureteral catheter placement, and the catheter was left in place for 2 months. During the follow-up period, the extravasation of urine stopped and hydronephrosis re- solved without any narrowing at the ureteral injury site. CONFLICT OF INTEREST None declared. REFERENCES 1. Demirkesen O, Tunç B, Ozkan B. A rare complication of lumbar disk surgery: ureteral avulsion. Int Urol Nephrol. 2006;38:459-61. 2. Trinchieri A, Montanari E, Salvini P, Berardinelli L, Pisani E. Renal autotransplantation for complete ureteral avulsion following lumbar disk surgery. J Urol. 2001;165:1210-1. 3. Turunç T, Kuzgunbay B, Gul U, Ozkardes H. Ureteral avulsion due to lumbar disc hernia repair. Can J Urol. 2010;17:5478-9. Vol 12 No 04 July-August 2015 2292 Ureteral Injury as an Outcome of Lumbar Disc Hernia Operation-Akpinar et al.