Ureteral injury after lumbar sympathetic block

Ureteral injury caused by lumbar sympathetic block is a rare but potentially serious complication. To date, seven cases have been reported in the literature [1-5]. The postulated etiology includes chemical irritation of the ureter and subsequent stenosis caused either by direct injection into the ureter or by spread of the agent from the injection site. Patients may present with symptoms ranging from systemic constitutional symptoms to more localized manifestations; timing of presentation may occur as early as 4 days and as late as 6 months post-procedure. Diagnosis is made by imaging, often initially including an ultrasound demonstrating a urinoma and/or hydronephrosis of the ipsilateral kidney. Management is patient-dependent and has ranged from conservative management with drainage to ureteral repair and nephrectomy.