Renal scintigraphy in evaluation of ureteral leak in patients with compromised renal function: Report of three cases

Ureteral injuries complicate 0.5-1% of pelvic surgeries in both genders. Diagnosis is usually delayed due to subtle presentation, causing accumulation of urea in the blood and acute renal injury. This prevents physicians from using contrast-based imaging modalities to locate the site of ureteral defect. We aim to reinforce the importance of renal scintigraphy in patients with ureter injury and coexisting renal functional compromise. Two cases of iatrogenic ureter injury and one case of a urinary leak following renal transplantation are presented. All three cases presented with increased creatinine level (due to delayed diagnosis) which made a CT scan, or intravenous pyelogram contraindicated. We used a Technetium-99m-L,L-ethylenedicysteine ([99mTc]Tc-EC) renal scan to locate the site of the ureteral defect without adversely affecting the renal function. In conclusion, [99mTc]Tc-EC is mainly excreted from nephron tubules and can be used in patients with decreased glomerular filtration rate with no additional harm to the kidney including in patients with delayed diagnosis of iatrogenic ureteral defect leading to acute kidney injury (AKI). While the CT scan or IVP was contraindicated, the [99mTc]Tc-EC renal scan located the ureteral defect without compromising kidney function, as [99mTc]Tc-EC is mainly excreted from nephron tubules and can be safely used in patients with AKI.