Reflex Anuria Following Laparoscopic Hysterectomy - Abstract
Introduction: Postoperative anuria strikes fear into the heart of gynaecologists; ureteric trauma or occlusion must be considered. If excluded non-mechanical causes must be sought. ‘Reflex anuria’ has been proposed as a rare cause. We present a case of anuria following laparoscopic hysterectomy and bilateral salpingooophorectomy (TLH + BSO) with a review of the literature regarding ‘reflex anuria’. The Case: A fit 85 year old lady underwent a TLH + BSO for endometrial cancer. She had a congenital single kidney with normal renal function. The procedure was completed satisfactorily; however in the immediate postoperative period she became anuric despite fluids and frusemide. Her serum creatinine increased from 78 to 187µmol/L over 12 hours. A nephrostomy was inserted for presumed ureteric obstruction, good urine output ensued and renal function improved. When a ureteric stent was passed the ureter was found to be patent. Discussion: Prompt management of anuria is essential to prevent permanent renal impairment. Post-hysterectomy, ureteric trauma must be investigated. Reflex anuria; no urine output in response to irritation of a kidney or ureter in the absence of mechanical obstruction, may be due to vascular or neurogenic stimuli, causing ureteric spasm. Some degree of ureteric spasm may occur in many patients undergoing pelvic surgery but with a single kidney, the effect was more profound in this case. Conclusion: We present an unusual case of anuria due to non-mechanical obstruction. The key to ensuring a good outcome is prompt investigation and management.