Ureterovaginal Fistula Research Articles

Laparoscopic Ureteric Reimplantation in Distal Ureteric Injury Post-total Laparoscopic Hysterectomy: A Case Series

ABSTRACT Introduction Ureteral injuries have been recognized as a potential complication of gynecological surgical procedures since the inception of our discipline; incidence ranging from 0.5 to 1.5% and morbidity associated with it may be serious. Traditionally, most ureterovaginal fistulas have been repaired by ureteroneocystostomy. Open ureteral reimplantation is a potentially morbid surgical procedure. Endourological techniques are highly successful in treating posthysterectomy ureteral injuries. The objective of this presentation is to relate our experience and result with laparoscopic ureteral reimplantation. Materials and methods Five patients with complaints of leakage of urine per vaginum postoperatively on day 12–24 (post-TLH) presented for treatment. After diagnosis, treatment of ureterovaginal fistula was performed completely laparoscopically. Laparoscopic ureteral reimplantation was done. Results No major intraoperative or postoperative complications were encountered. The operating room time was 120 minutes (range 120–240 minutes). The average hospital stay was 4 days. Patients had a successful outcome defined as no evidence of radiographic obstruction and no clinical complaints of persistent renal colic or any other urinary symptoms. Conclusion Our experience demonstrates that laparoscopic ureteral reimplantation is an effective minimally invasive treatment option for distal ureteral strictures. How to cite this article Dadhich CP, Mehta N, Dadhich T, et al. Laparoscopic Ureteric Reimplantation in Distal Ureteric Injury Post-total Laparoscopic Hysterectomy: A Case Series. J South Asian Feder Obst Gynae 2020;12(5):291–294.

Black pearl in urology: Inadvertent anastomosis of gonadal vein to ureter leading to malpostioning of stent into the inferior vena cava.

Double- J (JJ) stents are commonly used in urological procedures. Minor and self limiting complications are common following JJ stenting. Malpositioning of JJ stent into the vascular system is a rare and a possibly fatal complication. We are reporting a case of a malpositioned JJ stent in the inferior vena cava (IVC), during Boari flap procedure for post-hysterectomy uretereovaginal fistula. Patient had undergone hysterectomy three months previously, and had ureterovaginal fistula possibly due to iatrogenic intraoperative injury. Patient underwent right-sided ureteroneocystostomy with Boari flap one week previously at other institute. Patient was admitted in our institution with complaints of fever, pain in abdomen and vomiting. In view of the symptoms of the patient, cross-sectional imaging with computed tomography scan was done which revealed an intraoperatively malpositioned JJ stent in the IVC, and well healed Boari flap was seen.

Iatrogenic Genitourinary Fistula: Changing Trends

Aims: To study the frequency of iatrogenic cause amongst the surgery done for genitourinary fistula and to study the type and cause of iatrogenic genitourinary fistula.
 Methods: This is retrospective study of women undergoing surgery for genitourinary fistula repair from year 2013 to 2018. The analysis considers frequency and characteristics of type of fistula.
 Results: Out of 223 genitourinary fistula 75 (33.6%) were iatrogenic. Vaginal vault fistula were 25% followed by uretero-vaginal fistula (32.9%), vesico-vaginal fistula (32.9%) and there were 4 iatrogenic recto-vaginal fistula; 81.6% of the iatrogenic fistula had preceding history of hysterectomy followed by emergency caesarean section (17.1%). There is annual increasing trend in iatrogenic fistula repair from 3 to 23.
 Conclusions: Women undergoing hysterectomy were under risk for iatrogenic fistula. Optimum work environment is important to reduce surgical error during procedures. Operating training should be emphasised on optimal surgical skills, decision making.
 Keywords: genitourinary fistula, ureteric fistula, vault fistula

1704 Application of “Chopstick Technique” In Laparoendoscopic Single-Site Radical Hysterectomy: Initial Single-Institutional Experience for Early Stage Cervical Cancer

Study Objective This study aimed to describe the new “chopstick technique” in laparoendoscopic single-site radical hysterectomy (LESS-RH) and explore its feasibility, safety and perioperative outcomes in the treatment of early stage cervical cancer. Design Retrospective study. Setting The First Affiliated Hospital of Third Military Medical University, Chongqing, China. Patients or Participants Women with federation international of gynecology and obstetrics (FIGO) stage Ia1 with lymph vascular space invasion or stage Ia2-IIa2 cervical cancer. Interventions “Chopstick technique” was performed in LESS-RH and pelvic lymph node dissection. The demographic characteristics and perioperative efficacy of the patients were summarized and analyzed. Measurements and Main Results LESS-RH was attempted in 84 patients, and 83 (98%) patients underwent the procedure successfully. One patient underwent conversion to traditional laproscopic surgery secondary to phase IV endometriosis. “Chopstick technique” was used in all the 83 cases, wherein 40 cases used the single-incision three-channel laparoscopy platform, and 43 used the multichannel-tipped single port laparoscopy platform (HangT Port). The average operation time was 225.0±50.2min and the median intraoperative blood loss was 100mL. During the operations in the first 20 cases, 2 patients had intraoperative vascular injuries and 1 patient had bladder injury, and all were repaired under LESS. One case had ureterovaginal fistula 14 days after operation, and was successfully repaired by ureteroneocystostomy. The average number of pelvic lymph node dissections was 21, and the pathological examination of incisal edge was negative. Deep stromal invasion in 43 cases, LVSI in 16 cases,positive parametrium in 1 case, positive pelvic nodes in 15 cases. 33 patients were treated with postoperative chemotherapy and radiotherapy and 19 patients with intermediate risk factors were treated with radiotherapy postoperatively. Conclusion “Chopstick technique” under LESS was considered feasible for treating cervical cancer.

2287 Cystoscopy with Laparoscope Lens of 5 MM after Laparoscopic Hysterectomy, Experience in a Third Level Hospital

Study Objective Evaluate the detection of ureteral injuries with the use of laparoscopic lens of 5 mm and 30° for cystoscopy after total laparoscopic hysterectomy. Design Retrospective, descriptive, observational. Setting Third level hospital in the north of Mexico. Patients or Participants 135 patients scheduled for laparoscopic hysterectomy between march 2018 to march 2019, in a third level hospital in the north of Mexico. In four cases, laparoscopic surgery was converted to laparotomy due to bleeding, non-diagnosed ovarian malignancy, failure in the equipment, and patient's condition. Interventions No intervention. Measurements and Main Results Retrospective study of 131 patients who underwent a total laparoscopic hysterectomy, in which routinary diagnostic transoperative cystoscopy was made with a laparoscopic lens of 5 mm and 30°. The detection of 1 case of ureteral kinking was detected during the cystoscopies and one patient had an ureterovaginal fistula detected 7 days after de surgery. The results of cystoscopy after a laparoscopic hysterectomy has a sensibility of 50%, specificity of 100% and False Positive Ratio 0% and False Negatives Ratio 50% in identifying ureteral injuries. Conclusion The use of routinary cystoscopy during total laparoscopic hysterectomy has been debated previously. The detection rate in other studies reported that twice the injuries were detected during cystoscopy immediately after hysterectomy and delayed detection of ureteral injury decreased seven fold. Our study justifies the use of cystoscopy as a cost effective test, using only the 5 mm lens as the additional equipment required.

EP31.04: Saline infusion vaginography is an accurate novel method for detection of ureterovaginal fistula

EP31.04: Saline infusion vaginography is an accurate novel method for detection of ureterovaginal fistula

Lethal haemorrhage due to erosion of external iliac artery in a patient with ureterovaginal fistula following endometriosis surgery

We present a case report of a patient with laparoscopic surgery of a deep infiltrating endometriosis with a complicative course. In addition to a postoperatively diagnosed ureteral fistula with local inflammation, acute perforation and ultimately lethal bleeding from the adjacent external iliac artery occurred more than 3 weeks after surgery. To the best of our knowledge, a case with the same constellation has not yet been published. A literature review on the rare and comparable complication of a ureteroarterial fistula is discussed in connection with the case.

Laparoscopic repair of female genitourinary fistulae: 10-year single-center experience

Laparoscopic repair of different female genitourinary fistulae has been recently reported, including both conventional and laparoendoscopic single-site surgery (LESS). We present our 10-year single-center experience of the laparoscopic repair of different types of female genitourinary fistulae. A retrospective analysis of our records over the last 10years was performed. Type of fistula, etiology, laparoscopic approach, operative data, postoperative outcome, and follow-up were recorded. Overall, 46 patients with laparoscopic repair of genitourinary fistulae were reported: 25 had vesicovaginal fistulae (VVF), 14 had vesicouterine fistulae (VUF), and 7 had ureterovaginal fistulae (UVF). Thirty-three patients had conventional laparoscopic repair, whereas 7 VVF and 6 VUF had LESS repair. In all patients with VVF and VUF, extravesical repair was carried out by excising the fistulous tract and closing both the bladder and the vagina or the uterus with interposing tissue in-between. In patients with UVF, extravesical ureteric re-implantation was performed. Mean operative time was 176 ± 25min. Mean blood loss was 105 ± 25 cc. No intraoperative or postoperative complications occurred. None was converted to open surgery. Mean postoperative hospital stay was 3.2 ± 1.2days. After a mean follow-up of 6.3 ± 3.1years, all patients had undergone successful repair, except for one patient with complex VVF. Laparoscopic repair of VVF, VUF, and UVF is a feasible procedure with a high success rate and low morbidity. LESS repair of VVF and VUF has a comparable success rate to conventional laparoscopy, but with a shorter hospital stay and fewer analgesic requirements.

Incidence, type and management of ureteric injury associated with vesicovaginal fistulas: Report of a series from a specialized center

To report a large series of vesicovaginal fistula, and to assess the incidence of ureteric injury in association with vesicovaginal fistula. We retrospectively reviewed a prospective database of patients with vesicovaginal fistula referred to our center between 2004 and 2016. Data on patient demographics, fistula etiology, mode of repair, and any associated ureteric injury and its treatment were noted. Overall, 116 patients (median age 49years, range 23-88years) were referred for management of vesicovaginal fistula during the study period. Four of these patients (3.4%) had associated ureteric injury, one of whom had bilateral injury. Ureteric obstruction alone was noted in two patients, ureterovaginal fistula alone in one patient, and bilateral ureteric obstruction and ureterovaginal fistula in one patient. All ureteric injuries were managed with simultaneous reimplantation into the bladder at the time of vesicovaginal fistula repair. Five patients had post-radiotherapy vesicovaginal fistula, and the remainder were post-surgical. Three patients with post-radiotherapy vesicovaginal fistula proceeded to primary diversion. Ureteric injury is far less common than previously reported, occurring in <5% of patients presenting with vesicovaginal fistula. It can be successfully managed, and it remains the major indication for abdominal repair of vesicovaginal fistula.

Sudden fatal bleeding from a uretero-arterial fistula combined with pre-existing uretero-colic and uretero-vaginal fistulas 7\u2009years after a cervical cancer surgery: a case report

BackgroundUretero-arterial fistulas (UAFs) are a rare cause of hematuria and could be fatal often due to a diagnostic delay despite recent advances in the treatment modalities.Case presentationA 52-year-old woman with a history of advanced cervical cancer developed a fever and was diagnosed with a left uretero-colic fistula. She also had a uretero-vaginal fistula and suffered from repeated urinary tract infections over 6 years. While waiting for an elective colostomy, she developed sudden perineal bleeding and died 14 h after the onset. The autopsy findings revealed that bleeding from a newly developed UAF spreads out to the extracorporeal space through the pre-existing fistulas.ConclusionsBleeding from a UAF complicated by other uretero-genital and/or uretero-enteric fistulas could proceed rapidly resulting in a fatal outcome because of a lack of a tamponade effect. Early recognition of a UAF in high-risk patients is crucial for a prompt diagnosis, which might lead to a treatment success.

Iatrogenic Ureterovaginal Fistulae: Difficulties in Diagnosis and Treatment in Our Case series

Iatrogenic Ureterovaginal Fistulae: Difficulties in Diagnosis and Treatment in Our Case series

Spectrum of urologic complications in obstetrics and gynecology: 13 years’ experience from a tertiary referral center

To analyze the patterns of presentation and management for urologic complications of obstetrics and gynecology in the form of genitourinary fistulas at a tertiary referral center and highlight the social issues associated with them. We conducted this retrospective study analyzing 311 patients with genitourinary fistulas after obstetric and gynecologic surgeries between January 2005 and January 2018. We recorded the patients' characteristics and area of residence and then analyzed the etiology, surgical management and success rates by grouping the patients into four types of genitourinary fistulas. The primary end point of success was patient being leak free. Majority of patients (90.4%) were from rural areas. The distribution of genitourinary fistulas in descending order was vesicovaginal (79.7%), ureterovaginal (11.8%), urethrovaginal (10.2%) and vesicouterine fistulas (2.6%). The mean time to presentation was 25.80±48.69 days with a wide range of 10 days to 360 months. The most common etiology was obstructed labour (58.5%) followed by abdominal hysterectomy (32.7%). For vesicovaginal fistulas the route to be used for repair depended on surgeon's preference and both transabdominal and transvaginal routes had almost equal success rates. The success rate of laparoscopic vesicovaginal fistula repair was 89.4% and all (100%) laparoscopic ureteroneocystostomies were successful. Genitourinary fistulas especially due to obstructed labour are still common in developing world showcasing the problem of inequitable distribution of healthcare. The surgical treatment approach depends on the surgeon's familiarity with the said procedure although versatility is required.

Clinical Outcomes of Total Laparoscopic Hysterectomy (TLH): Seven Years’ Experience in a Public Hospital

Objective: The aim of the study was to explore the surgical outcomes of total laparoscopic hysterectomy.&#x0D; Materials and methods: This was a prospective analysis of total Laparoscopic Hysterectomy (TLH) done between January, 2012 to December, 2018 in Shaheed Suhrawardy Medical College and Hospital. Demographic data, clinical criteria, intra operative and postoperative outcome data were recorded. Data were collected in a predesigned Data collection sheet. Follow up records done during discharge from the hospital, one week and four weeks postoperatively.&#x0D; Results: Total 298, laparoscopic hysterectomy were performed during the period. Among them 96 % (n=286) for benign and 4 %( n=12) for malignant condition were included in the study population. Mean age of the patients was 45.4 ± 5.6 years, mean parity was 1.9 ± 0.64 and the mean body mass index was 27.48 ± 0.57. The most common benign disease was leiomyoma, 51.7 %. Among the study cases 21.8% (n=65) had history of at least one previous abdomino-pelvic surgery. Maximum size of uterus removed was 28 weeks and maximum patients, 48% (n=143) had uterine size of 10-14 weeks. The operating time was variable between 50 min to 180 min and in the course of time, the mean operating time dropped from 130 min to 60 min. The mean length of hospital stay was 2 days and the return to normal activities was within 2 weeks. Major complications observed among 3.7 % of cases among them 2(0.67%) bladder injury, 2(0.67%) vesico-vaginal fistula (VVF), 3(1.0%) ureterovaginal fistula (UVF) and 4(1.3%) peroperative hemorrhage requiring blood transfusion. Among the 7 cases of urological complications, one patient with VVF and one patient with UVF needed relaparotomy. Ultimately all cases were managed without any residual problem. Conversion to laparotomy was 0.3 % (n=1) of case.&#x0D; Conclusion: TLH offers the benefit of minimally invasive surgery to the patient and is a safe and acceptable alternative to standard hysterectomy for various gynaecological indications.&#x0D; Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 28-35

Iatrogenic Ureterovaginal Fistulae: Difficulties in Diagnosis and Treatment in Our Case series

Ureteral injury is a known complication of pelvic surgeries, including gynecological, urologic, colorectal, and vascular surgeries. This can occur by transvaginal, laparoscopic, or transabdominal approach [1,2]. Gynecological surgery remains by far the most common means of injury (75%), followed by colorectal surgeries (14%) [3-5], with reports of ureteral injury during gynecologic surgery from 0.35% to 1.5% [4,6]. Total abdominal and laparoscopic hysterectomies are the most common procedures where ureteral injury occurs [1,5]. Injury occurs most often at the level where the ureter courses under the uterine vessels, followed by the ureterovesical junction and the base of the infundibulopelvic ligament [4,7,8]. Many ureteral injuries occur during uncomplicated, routine surgery [8,9]. An abnormal connection between the ureter and vagina, or ureterovaginal fistula, allows for a conduit through which urine can continually leak. This is specific to the combination of ureteral injury and hysterectomy where the urine finds its way to the freshly closed vaginal cuff. Genitourinary fistula formation remains one of the most feared complications of pelvic surgery, with lasting emotional damage, risk for infections, infertility, reoperation, and increased hospital stay [5,10]. Our objective is to present the difficulties encountered in management of our cases and how to rectify them.

Approach to Ureterovaginal Fistula: Examining 13 Years of Experience.

We describe the management and outcomes of ureterovaginal fistulas over a 13-year period and present a treatment algorithm. We performed a review of ureterovaginal fistula cases between January 2005 and December 2017 at our tertiary academic center. Demographics, diagnostic approaches, and treatment outcomes were assessed. Nineteen cases of ureterovaginal fistula were identified. Fistulas developed after hysterectomy in 18 cases and cesarean delivery in 1 case. Our primary treatment was conservative management with ureteral stenting in 12 and reimplantation in 6 cases. There was 1 case of spontaneous resolution. Ureteral stenting was successful in 11 (92%) of 12 patients. Stents were left in place for an average of 66 days (27-92 days). Complications of stents included pyelonephritis in 2 cases (18%) and stricture in 1 case (9%). Ultimately, conservative management was successful in treating ureterovaginal fistulas in 10 (83%) of 12 cases. The indications for primary ureteral reimplantation were concurrent vesicovaginal fistula in 3 cases, history of ureteral injury with surgical repair during the index surgery in 2 cases, and a 1-year delay in diagnosis in 1 case. A variety of follow-up surveillance methods were used, including tampon tests, computed tomographic urograms, retrograde pyelograms, and MAG-3 Lasix renal scans. In carefully selected patients, ureteral stenting results in high cure rates for posthysterectomy ureterovaginal fistulas and should be considered first-line therapy. Complicated ureterovaginal fistulas may be best managed by primary ureteral reimplantation.

Our Experience with Iatrogenic Ureteric Injuries among Women Presenting to University College Hospital, Ibadan: A Call to Action on Trigger Factors.

Background Ureteric injuries leading to ureterovaginal fistula (UVF) is less common than vesicovaginal fistula, as a cause of urinary incontinence. Recently, there is a surge in the number of UVF cases presenting to University College Hospital (UCH) following a caesarean delivery. The urogynaecology unit at UCH is at the forefront of providing surgical repair for women with all forms of genitourinary fistulas. We describe our experience with managing UVF arising from ureteric injury. Methods A retrospective data collection of UVF cases managed from January 2012–December 2017 at UCH is presented. Information on sociodemographic and obstetric characteristics, presenting complaints, antecedent surgery, treatment received, findings at surgery, and postoperative complications were obtained with a structured proforma. Results Eighteen cases of UVFs due to iatrogenic ureteric injury were managed. Majority (N=11; 61.1%) of the women suffered the injury following the emergency caesarean section (EMCS). Abdominal hysterectomy operation accounted for four (22.2%) cases, and one case each (5.6%) was due to vaginal hysterectomy and destructive operations. Prolonged obstructed labour (POL) (81.8%) was the most common indication for the EMCS, while 18.2% had surgery on account of lower uterine segment fibroid. Most of the ureteric injuries were on the left side. Postoperative complications documented were haemorrhage, urinary tract infection, wound infection, and injury to the neighbouring structure. Conclusion Caesarean section being one of the most performed surgical operations in Nigeria was surprisingly found to be the most common cause of ureteric injury ahead of hysterectomy. It is a pointer that the surgeons might not have properly learnt the art of the caesarean delivery well. We recommend adequate surgical training of medical officers/surgeons that are involved.

Experience of Managing Ureterovaginal Fistulas following Obstetric and Gynecological Surgeries

Aims: Iatrogenic ureteric injuries leading to fistula are rare but devastating complications of obstetric and gynecological surgeries.The aim of the study is to review the demography of ureterovaginal fistula (UVF) and its surgical outcome in the starting phase of fistula surgery.&#x0D; Methods: This is a retrospective review of 15 patients of ureterovaginal fistula who were referred to department of Obstetrics and Gynaecology of Kathmandu Model Hospital from Feb 2014 to Sept 2017. The study reviewed the demography, causes and surgical outcome of ureterovaginal fistula (UVF). Ten patients who had complete blind end at the distal ureter undergone Lich-Gregoir extravesicalur enteroneocystostomy. In other 5 patients, guide wire was successfully negotiated beyond the fistula site, however retrograde double J stenting could be done in only 4 patients.&#x0D; Results: All the patients had distal ureteric injury close to vesicoureteric junction leading to ureterovaginal fistula. Among them, majority were due to post hysterectomy 60% (n=9) followed by obstetrics procedures (caesarean section) 40% (n=6). Fourteen patients (93%) had successful closure of the fistula with complete preservation of renal function till date. Retrograde double J stenting was possible in patients who were referred earlier within two weeks of the onset of injury.&#x0D; Conclusions: In our short review, iatrogenic injury to the distal ureter during Obstetrics/Gynaecologic surgery was found to be the leading cause for the formation of ureterovaginal fistula. Endoscopic management with ureteric stents is still possible if the patients are referred earlier following primary surgery.

Genital tract fistula: Changing trends in presentation and outcome

Aims: To find out the clinical profile of obstetric fistula.&#x0D; Methods: A retrospective review of women presenting for OF repair in Ibadan, Oyo State from 2017-2018. All repairs were performed by the Oyo State fistula team at Adeoyo Maternity Hospital or University College Hospital, Ibadan. Two hundred and eighteen women were repaired during the period; information on socio-demographic and presentation characteristics was extracted. Data analysis was done using IBM SPSS version 25.0.&#x0D; Results: The commonest cause of genital tract fistula in this review was obstructed labour (68.5%), 44.9% of the women had caesarean delivery either to relieve obstruction or as elective procedure. Only 8.3% had elective caesarean section and 5.6% had gynaecologic surgery. Majority were urinary fistula (92.5%) and in the mid-vaginal (21.6%) location followed by juxta-cervical and ureterovaginal fistula (9.2%). Urethral involvement and severe vaginal fibrosis were seen in 12.4% and 61.3% of cases respectively.&#x0D; Conclusions: There is a need for continuing medical education on critical emergency obstetric care skills in order to improve maternal health care service delivery.

Genito urinary fistula: a series of 1704 cases

Aims: To review our experience in causes, diagnosis and basic principles of surgical treatment of urogenital fistulas.&#x0D; Methods: A retrospective study of 1704 patients with different types of urogenital fistulas were reviewed between October 1995 to October 2018. They were analyzed with regard to age, parity, casual factor, mode of treatment and outcome. Patients were also evaluated at two or three weeks initially, three monthly and later depending upon symptoms.&#x0D; Results: We reviewed our series of female urogenital fistulas that have been treated over a 22 years period. Out of these 1704 cases 864 (62.44%) were Vesico vaginal fistulas, 432 (25.35%) were Urethro vaginal fistulas and 188 (12.2%) were Uretero vaginal. Majority of the patients were young in child bearing age between 16 and 30 years of age, although age range was wide i.e., 11 to 50 years. The most common cause of urogenital fistulas were Obstetrical trauma due to obstructed labor in 400(37.59%) &amp; Gynecological (hysterectomy 180(18.79%) &amp; caesarian section in 72 (6.77%). Patients of Uretero vaginal fistulas were mainly due to unrecognized ureteral injuries during Gynecological procedures (hysterectomy in 136 cases &amp; caesarian section in 10 cases. For repair of vesico vaginal fistulas Transvaginal route for repair was used in 424(39.84%) patients, while Thans abdominal route for repair was used in 560 (52.63%) patients. There were 32 (12.03%) failures in Vesico vaginal fistulas with a success rate of 88%. Mean Hospital stay was 15+ 3.5 days (range 4-30 days) and a mean follow-up of 8+ 3.2 months (range 4 months to 2 years).&#x0D; Conclusions: Management of Urogenital fistulas are among the most distressing complications of obstetric and gynecologic procedures. The patients suffer physically, emotionally and socially. The lack of skilled supervision and adequate obstetric emergency facilities are to blame.

Post Abdominal Hysterectomy Ureterovaginal Fistula

Ureteric injury can occur during any pelvic or abdominal surgeries. Gynecological surgeries especially total abdominal hysterectomy is one of the common cause of iatrogenic ureteric injury leading to ureterovaginal fistula. A 35 years lady had continuous leaking of urine per vagina from 25th day after total abdominal hysterectomy. Her CT urogram showed left distal ureterovaginal fistula and she underwent left ureteroneocystostomy. A good knowledge of pelvic anatomy is necessary along with a good surgical skill to prevent ureteric injury during surgery.&#x0D; Keywords: DJ stent, ureteric injury, ureterovaginal fistula.