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
International Urogynecology Journal – Springer Journals
Published: May 31, 2018
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