Successful treatment of the uretero-vaginal fistula after gynecologic surgery using ureteroscopic ureter double-J stenting, a case report.
Yen-Ting, Wu, Yuan Tso Cheng
Department of Urology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Purpose: Ureter injury is a relative common intraoperative complication in gynecologic and proctologic surgery. Surgical treatment is usually inevitable to rebuilt urinary tract. We report a case with iatrogenic ureter injury and ureteral mucosa healed after double J stenting for 4 months.
Case presentation: This 38-year-old woman had no underlying systemic disease. She received total hysterectomy and bilateral salpingo-oophorectomy for endometrial endometrioid carcinoma (FIGO stage IA). A few days after operation, lower abdominal pain developed. There was also left back soreness, urinary incontinence, and intermittent low-grade fever. Vaginal examination found urine leakage from vaginal cuff. Blood biochemical test revealed acute kidney injury. CT urography reported narrowing of left lower ureter causing mild left hydroureteronephrosis. Ureteroscopy revealed severe ureteral stricture over right lower ureter (1.5cm from ureterovesical junction). There was visible suture material suspect Vicryl over stricture site. Stricture site was passed with force and assist of ureteral catheter, followed by double J stenting with tumor stent (Bard Medical, USA). Four months later, ureteroscopy for follow-up showed healed urothelium in left lower ureter.
Discussion: Because the ureters are proximal to abdominal and pelvic organs, they are susceptible to iatrogenic injury. Management of ureteral injury, which depends on location, length, degree of injury, and timing of diagnosis, include endoscopic management, pyeloplasty, ureteroureterostomy, ureteroneocystostomy, and even autotransplantation are possible options. Severe lower ureter injury usually requires ureteroneocystostomy to rebuild urinary tract. Our case indicates that simple endoscopic management still could be considered for patient with severe ureter injury.