Ureteral Injury with Delayed Massive Hematuria after Transvaginal Ultrasound-Guided Oocyte Retrieval.

Tanja Burnik Papler,Vesna Šalamun,Nina Jančar,Eda Vrtačnik Bokal,Tomaž Smrkolj,Dejan Galič

doi:10.1155/2015/760805

Abstract

We report a case of ureteral injury with delayed hematuria after transvaginal oocyte retrieval. A 28-year-old infertile patient with a history of previous laparoscopic resection of endometriotic nodes of both sacrouterine ligaments presented with abdominal pain one day after oocyte retrieval. Four days after oocyte retrieval, she presented with massive hematuria that reappeared 6 days after oocyte retrieval. Monopolar coagulation with wire electrode and insertion of a double-J-stent was performed during operative cystoscopy. The patient recovered completely after transfusion and had no signs of renal impairment after ureteric stent removal. This is the first report of ureteral injury after oocyte retrieval presenting itself with delayed massive hematuria and no signs of renal dysfunction or urinary leakage into retroperitoneal space.

Highlights

Transvaginal ultrasound-guided oocyte retrieval is a standard method in women undergoing IVF procedures
We report for the first time a case of ureteral injury that presented with delayed massive hematuria without urinary tract signs of peritoneal irritation 4 and 6 days after ultrasound-guided transvaginal oocyte retrieval
The reported ureteral injuries resulted in ureteric obstruction and hydronephrosis [5, 8, 11], ureteric transection or stricture requiring surgical reimplantation [6, 7], urine leakage into retroperitoneal space [9], ureterovaginal fistula [6, 10], and, in the most severe case with delayed diagnosis, unilateral kidney failure requiring nephrectomy [5]

Summary

Introduction

Transvaginal ultrasound-guided oocyte retrieval is a standard method in women undergoing IVF procedures. The method was described by Wikland et al [1], and it is preferred to laparoscopic or transabdominal oocyte retrieval, since it is less invasive. Cases of bleeding [2], infection [3], and injuries of the adjacent organs [4] have been described after this procedure. We report for the first time a case of ureteral injury that presented with delayed massive hematuria without urinary tract signs of peritoneal irritation 4 and 6 days after ultrasound-guided transvaginal oocyte retrieval

Case Presentation

Discussion