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Laparoscopic management of severe ureteral obstruction after vaginal hysterectomy and colposuspension

Laparoscopic management of severe ureteral obstruction after vaginal hysterectomy and... 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 obstruc- tion, which was corrected, and a new vault suspension performed using the laparoscopic approach. Prophylactic ureteral stent positioning was http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Urogynecology Journal Springer Journals

Laparoscopic management of severe ureteral obstruction after vaginal hysterectomy and colposuspension

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Publisher
Springer Journals
Copyright
Copyright © 2018 by The International Urogynecological Association
Subject
Medicine & Public Health; Gynecology; Urology
ISSN
0937-3462
eISSN
1433-3023
DOI
10.1007/s00192-018-3675-6
Publisher site
See Article on Publisher Site

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 obstruc- tion, which was corrected, and a new vault suspension performed using the laparoscopic approach. Prophylactic ureteral stent positioning was

Journal

International Urogynecology Journal – Springer Journals

Published: May 31, 2018

References

  • A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments
    Shull, BL; Bachofen, C; Coates, KW
  • Bilateral uterosacral ligament vaginal vault suspension with site specific endopelvic fascia defect repair for treatment of pelvic organ prolapse
    Barber, MD; Visco, AG; Weidner, AC
  • Management of ureteric injuries during gynecological operations: 10 years experience
    Sakellariou, P; Protopapas, AG; Voulgaris, Z
  • The incidence of ureteral obstruction and the value of intraoperative cystoscopy during vaginal surgery for pelvic organ prolapse
    Gustilo-Ashby, AM; Jelovsek, JE; Barber, MD