1.1. Background: Ureteral injury is an uncommon surgical complication and it is estimated that 52-82% of iatrogenic injuries occur during gynecologic surgery. The most common injury is inadvertent ligation of the ureter, with consequent ureteral kinking and obstruction.
1.2. Study Objective: To report the vaginoscopic treatment of an iatrogenic ureteral injury in a young patient who underwent abdominal hysterectomy.
1.3. Design: Step-by-step video presentation of the surgical treatment [1-6].
1.4. Intervention: A 36 years old woman was referred to our Department with pain and heavy vaginal bleeding. The patient had a previous diagnosis of cervico-isthmic pregnancy which was removed by dilatation and suction at 10 weeks of gestation. After four days she underwent abdominal hysterectomy for uterine rupture. Four days after hysterectomy, the patient complained of lower back pain. Computerized tomography scan revealed a right ureteral injury determining ureteral stenosis near vaginal vault and the presence of ureteronephrosis. The fluoroscopy confirmed the complete stenosis, in fact neither the ureteral catheter nor the contrast medium could pass through the lower ureteral tract. Before scheduling the patient for a re-laparotomy, she underwent a vaginoscopy in inpatient setting. At vaginoscopy three stitches near the vaginal vault were identified, clogging the placement of ureteral stent. The surgical strategy was to cut the stitches in the right portion of the vaginal vault starting from the more lateral ones and progressively moving to the more medial ones. The stitches were removed carefully with 5 Fr blunt scissor, obtaining the restoring of ureteral patency.
1.5. Conclusion: Our case shows that in case of low ureteral stenosis (i.e. close to the vaginal vault) vaginoscopy could be used as a diagnostic and therapeutic tool. Larger series are needed to evaluate the potential of vaginoscopy in the management of this frequent iatrogenic complication.
- Keywords: Gynecologic Surgery; Ureteral Injuries; Vaginal Vault; Vaginoscopy
3. Ozdemir E, Ozturk U, Celen S, Sucak A, Gunel M, et al. (2011) Urinary complications of gynecologic surgery: iatrogenic urinary tract system injuries in obstetrics and gynecology operations. Clin Exp Obstet Gynecol 38: 217-220.
6. Giampaolino P, D'Apolito A, Bifulco G, Di Spiezio Sardo A (2017) Vaginoscopic Identification of an Isolated Vaginal Vault Recurrence of Endometrial Cancer. J Minim Invasive Gynecol S1553-4650: 31154-31158.