V180 ENDOSCOPIC REALIGNMENT OF TRAUMATIC COMPLETE URETERIC DISRUPTION WITH URETEROVAGINAL FISTULA (UVF)

Abstract

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction & Incontinence)1 Apr 2010V180 ENDOSCOPIC REALIGNMENT OF TRAUMATIC COMPLETE URETERIC DISRUPTION WITH URETEROVAGINAL FISTULA (UVF) Hemendra Shah Hemendra ShahHemendra Shah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.235AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To describe the technique of combined percutaneous antegrade & ureteroscopic retrograde approach in endourological management total ureteral disruption with ureterovaginal fistula (UVF). METHODS From January 2000 to September 2009, nine diagnosed cases of post laparoscopic hysterectomy ureterovaginal fistula had complete ureteric discontinuity on retrograde pyelography. They were managed endourologically with a combined percutaneous antegrade & ureteroscopic retrograde approach for ureteric stenting. After initial ureteroscopic confirmation of complete ureteric discontinuity, a glide wire was negotiated through the percutaneous renal puncture so as to reach the site of ureteric trauma. These glide wire was retrieved retrogradely with the ureteroscopic grasping forcep under combined ureteroscopic and fluoroscopic guidance. A ureteric stent was placed over this glide wire for realignment of disrupted ureter. At the end of procedure, an 8 Fr. Pigtail nephrostomy catheter was placed for performing nephrostogram a week later. The ureteric stent was left insitu for 3 months. Follow-up intravenous urogram (IVU) was performed at 6 months and than yearly to look for development of ureteric stricture. RESULTS Endoscopic realignment of traumatic complete ureteric disruption was successful in all nine patients. Two patients had extravasation of contrast or leakage of methylene blue in vagina during follow-up nephrostogram at 1 and 2 weeks. Both these patients were successfully managed by laparoscopic ureteric reimplantation. In remaining patients, the fistula healed. One patient required balloon dilatation and Holmium laser endoureterotomy for stricture that was diagnosed at 6-month follow-up. At mean follow-up of 53.4 months (range 2 - 92 months) all patients are asymptomatic. CONCLUSIONS Present approach represents a feasible, minimally invasive alternate for treatment of the total ureteral disruption and ureterovaginal fistula. However, a longer follow-up with more number of patients is necessary to substantiate our results. Mumbai, India© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e72 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hemendra Shah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...