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International Urogynecology Journal

, Volume 29, Issue 10, pp 1557–1558 | Cite as

Laparoscopic management of severe ureteral obstruction after vaginal hysterectomy and colposuspension

  • Renato Seracchioli
  • Diego RaimondoEmail author
  • Paolo Salucci
  • Roberto Paradisi
  • Mohamed Mabrouk
IUJ Video
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Abstract

Introduction and hypothesis

After vaginal hysterectomy, uterosacral ligaments are commonly used to suspend the vaginal vault in order to prevent and to treat recurrence of central prolapse. Shull et al. proposed a technique to fix endopelvic fascia and vagina to the higher portion of the uterosacral ligaments using a vaginal approach [1]. This technique is associated with a risk of ureteral obstruction (0–11%) [2, 3]. Although intraoperative cystoscopy is recommended to check ureteral patency at the end of colposuspension, this secondary prevention technique could be false negative due to partial stenosis [4].

Methods

A 60-year-old woman with stage 3 uterine and anterior compartment descensus assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system underwent vaginal hysterectomy, bilateral adnexectomy, and vaginal vault suspension to the uterosacral ligaments using the Shull technique. Intraoperative cystoscopy with indigo carmine was negative. On postoperative day 0, the patient complained left flank pain. Transabdominal ultrasound showed a left hydroureteronephrosis without ureteral stones, which was confirmed by uro-computed tomography scan. The attempts of ureteral stent positioning and opening the vaginal vault failed to resolve the ureteral obstruction, which was corrected, and a new vault suspension performed using the laparoscopic approach. Prophylactic ureteral stent positioning was performed. Informed consent was obtained from the patient for publication of this case report.

Results

The patient was discharged on postoperative day 5 with normal renal function. The ureteral stent was removed after 1 month, and renal ultrasound at 3 and 6 months’ follow-up showed normal renal pelvis caliber. No recurrence of genital prolapse was observed at gynecological examination.

Conclusions

Laparoscopy can be a wise alternative option to manage ureteral obstruction secondary to vaginal colposuspension for genital organ prolapse.

Keywords

Colposuspension Ureteral obstruction Laparoscopy 

Notes

Compliance with ethical standards

Conflicts of interest

None.

Consent

Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Supplementary material

ESM 1

(MP4 123,859 kb)

References

  1. 1.
    Shull BL, Bachofen C, Coates KW, et al. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol. 2000;183:1365–74.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Barber MD, Visco AG, Weidner AC, et al. Bilateral uterosacral ligament vaginal vault suspension with site specific endopelvic fascia defect repair for treatment of pelvic organ prolapse. Am J Obstet Gynecol. 2000;183:1402–11.CrossRefGoogle Scholar
  3. 3.
    Sakellariou P, Protopapas AG, Voulgaris Z, et al. Management of ureteric injuries during gynecological operations: 10 years experience. Eur J Obstet Gynecol Reprod Biol. 2002;101:179–84.CrossRefGoogle Scholar
  4. 4.
    Gustilo-Ashby AM, Jelovsek JE, Barber MD, et al. The incidence of ureteral obstruction and the value of intraoperative cystoscopy during vaginal surgery for pelvic organ prolapse. Am J Obstet Gynecol. 2006;194:1478–85.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  1. 1.Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola HospitalUniversity of BolognaBolognaItaly
  2. 2.Department of Obstetrics and Gynecology, Faculty of MedicineUniversity of AlexandriaAlexandriaEgypt

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