Recurrent Paravaginal Abscess: An Unusual Presentation of a Distal Ectopic Ureteral Remnant after Prior Nephrectomy

Abstract

Study Objective Describe a patient with OHVIRA syndrome and demonstrate the surgical technique used to treat her paravaginal abscess and remnant ectopic ureter. Design Video case-presentation. Setting Academic hospital. Patients or Participants Single patient. Interventions Surgery. Measurements and Main Results We describe a patient who initially presented at the onset of menarche with cyclic abdominopelvic pain. She was diagnosed with uterine didelphys with obstructed right hemivagina. She underwent a vaginoplasty, which was followed by postoperative urinary incontinence. Further work-up indicated a dysplastic right kidney with ectopic ureter to the right vaginal sidewall, correlating with diagnosis of OHVIRA syndrome. She then represented at 21 years old with chronic vaginal drainage. She underwent an extensive evaluation including imaging as well diagnostic procedures, including: cystovaginoscopy, hysteroscopy and laparoscopy. She was tested for sexually transmitted diseases, put on multiple courses of antibiotics, and had two drains placed with recurrence of drainage. When she finally presented to our facility, there was concern for abscess secondary to remnant distal ectopic ureter into the vagina. She underwent an office examination and vaginoscopy, confirming drainage from a right vaginal ostium. She was counseled and ultimately underwent a robotic assisted laparoscopic excision of paravaginal abscess and remnant of distal right ectopic ureter. She did well postoperatively. Interval CT scan on post-operative day 15 demonstrated fluid collection, which was drained by interventional radiology. The fluid collection resolved, drain removed and she has had no further recurrence of drainage. Conclusion This is an unusual presentation of a recurrent paravaginal abscess in the setting of prior partial right ectopic ureterectomy. We describe the innovative and successful surgical technique used to identify and excise the paravaginal abscess and distal ectopic ureter. Highlighting this patient's unique anatomy and the importance of complete resection of an ectopic ureter to the vagina at the time of nephrectomy due to potential risk of ascending chronic infection and abscess formation. Describe a patient with OHVIRA syndrome and demonstrate the surgical technique used to treat her paravaginal abscess and remnant ectopic ureter. Video case-presentation. Academic hospital. Single patient. Surgery. We describe a patient who initially presented at the onset of menarche with cyclic abdominopelvic pain. She was diagnosed with uterine didelphys with obstructed right hemivagina. She underwent a vaginoplasty, which was followed by postoperative urinary incontinence. Further work-up indicated a dysplastic right kidney with ectopic ureter to the right vaginal sidewall, correlating with diagnosis of OHVIRA syndrome. She then represented at 21 years old with chronic vaginal drainage. She underwent an extensive evaluation including imaging as well diagnostic procedures, including: cystovaginoscopy, hysteroscopy and laparoscopy. She was tested for sexually transmitted diseases, put on multiple courses of antibiotics, and had two drains placed with recurrence of drainage. When she finally presented to our facility, there was concern for abscess secondary to remnant distal ectopic ureter into the vagina. She underwent an office examination and vaginoscopy, confirming drainage from a right vaginal ostium. She was counseled and ultimately underwent a robotic assisted laparoscopic excision of paravaginal abscess and remnant of distal right ectopic ureter. She did well postoperatively. Interval CT scan on post-operative day 15 demonstrated fluid collection, which was drained by interventional radiology. The fluid collection resolved, drain removed and she has had no further recurrence of drainage. This is an unusual presentation of a recurrent paravaginal abscess in the setting of prior partial right ectopic ureterectomy. We describe the innovative and successful surgical technique used to identify and excise the paravaginal abscess and distal ectopic ureter. Highlighting this patient's unique anatomy and the importance of complete resection of an ectopic ureter to the vagina at the time of nephrectomy due to potential risk of ascending chronic infection and abscess formation.