Abstract
Introduction: Ureteral injuries are relatively common in gynecological procedures. The repair of such injuries has traditionally been done through open surgery; however, minimally invasive techniques have become an option in some cases. We report the case of a ureteroureteral anastomosis successfully transvaginally approached. Case report: a 70-year-old woman developed hydronephrosis and acute renal failure after vaginal hysterectomy, parametrectomy, McCall culdoplasty, sacrocolpopexy, posterior colpoplasty and perineoplasty. She was reoperated, and had bilateral ureteral injuries correctly identified and repaired through the vaginal route. Discussion: Difficulties encountered during transvaginal surgery include ureter identification and the narrow surgical field. In order for a vaginal repair to be performed, surgeons must have expertise with vaginal surgery and know the anatomy of the ureter as seen through the vagina. Additionally, JJ stents can be used to facilitate repair. Conclusion: Vaginal repair of ureteral injuries is feasible and has potentially less morbidity than the standard abdominal approaches, but further studies are needed in order to determine its efficacy and complication rates.
Highlights
Ureteral injuries are relatively common in gynecological procedures
We report the case of a ureteroureteral anastomosis successfully transvaginally approached
Vaginal repair of ureteral injuries is feasible and has potentially less morbidity than the standard abdominal approaches, but further studies are needed in order to determine its efficacy and complication rates
Summary
Rare in most surgeries, ureteral lesions are relatively common complications of gynecological procedures.[1]. Transvaginal view of the individualized ureter (with JJ stent), before being reanastomosed (shown with Adson forceps). Serum creatinine levels were 7.2 mg/dl and blood urea nitrogen (BUN) levels were 42.1 mg/dl This patient was reoperated in order to have JJ stents placed (Figures 1 and 2) and the ureteric reanastomosis performed (Figure 3). The sutures in the posterior vaginal wall and vaginal cuff were removed Through this view, sectioned portions of the right ureter were identified, a JJ stent was placed, and the ureter was reanastomosed terminoterminally. Individualized ureter after transvaginal reanastomosis (shown with Mixter forceps) Her acute renal failure significantly improved, and this patient presented with spontaneous diuresis on the first day after her second surgery. This woman was discharged and continued to receive outpatient care, with normal kidney function at follow-up
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