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.