Laparoscopic management of severe ureteral obstruction after vaginal
hysterectomy and colposuspension
Received: 6 March 2018 / Accepted: 15 May 2018
The International Urogynecological Association 2018
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 . 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 .
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 performed. Informed consent was obtained from the patient for publication of this case
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.
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.
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–
2. Barber MD, Visco AG, Weidner AC, et al. Bilateral uterosacral lig-
ament vaginal vault suspension with site specific endopelvic fascia
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00192-018-3675-6) contains supplementary
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* Diego Raimondo
Gynaecology and Human Reproduction Physiopathology, DIMEC,
S. Orsola Hospital, University of Bologna, 13, via Massarenti,
40138 Bologna, Italy
Department of Obstetrics and Gynecology, Faculty of Medicine,
University of Alexandria, Alexandria, Egypt
International Urogynecology Journal