Tags

Type your tag names separated by a space and hit enter

Laparoscopic management of severe ureteral obstruction after vaginal hysterectomy and colposuspension.
Int Urogynecol J 2018; 29(10):1557-1558IU

Abstract

INTRODUCTION AND HYPOTHESIS

After vaginal hysterectomy, uterosacral ligaments are commonly used to suspend the vaginal vault in order to prevent and to treat recurrence of central prolapse. Shull et al. proposed a technique to fix endopelvic fascia and vagina to the higher portion of the uterosacral ligaments using a vaginal approach [1]. This technique is associated with a risk of ureteral obstruction (0-11%) [2, 3]. Although intraoperative cystoscopy is recommended to check ureteral patency at the end of colposuspension, this secondary prevention technique could be false negative due to partial stenosis [4].

METHODS

A 60-year-old woman with stage 3 uterine and anterior compartment descensus assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system underwent vaginal hysterectomy, bilateral adnexectomy, and vaginal vault suspension to the uterosacral ligaments using the Shull technique. Intraoperative cystoscopy with indigo carmine was negative. On postoperative day 0, the patient complained left flank pain. Transabdominal ultrasound showed a left hydroureteronephrosis without ureteral stones, which was confirmed by uro-computed tomography scan. The attempts of ureteral stent positioning and opening the vaginal vault failed to resolve the ureteral obstruction, which was corrected, and a new vault suspension performed using the laparoscopic approach. Prophylactic ureteral stent positioning was performed. Informed consent was obtained from the patient for publication of this case report.

RESULTS

The patient was discharged on postoperative day 5 with normal renal function. The ureteral stent was removed after 1 month, and renal ultrasound at 3 and 6 months' follow-up showed normal renal pelvis caliber. No recurrence of genital prolapse was observed at gynecological examination.

CONCLUSIONS

Laparoscopy can be a wise alternative option to manage ureteral obstruction secondary to vaginal colposuspension for genital organ prolapse.

Authors+Show Affiliations

Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, 13, via Massarenti, 40138, Bologna, Italy.Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, 13, via Massarenti, 40138, Bologna, Italy. die.raimondo@gmail.com.Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, 13, via Massarenti, 40138, Bologna, Italy.Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, 13, via Massarenti, 40138, Bologna, Italy.Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, 13, via Massarenti, 40138, Bologna, Italy. Department of Obstetrics and Gynecology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

29855661

Citation

Seracchioli, Renato, et al. "Laparoscopic Management of Severe Ureteral Obstruction After Vaginal Hysterectomy and Colposuspension." International Urogynecology Journal, vol. 29, no. 10, 2018, pp. 1557-1558.
Seracchioli R, Raimondo D, Salucci P, et al. Laparoscopic management of severe ureteral obstruction after vaginal hysterectomy and colposuspension. Int Urogynecol J. 2018;29(10):1557-1558.
Seracchioli, R., Raimondo, D., Salucci, P., Paradisi, R., & Mabrouk, M. (2018). Laparoscopic management of severe ureteral obstruction after vaginal hysterectomy and colposuspension. International Urogynecology Journal, 29(10), pp. 1557-1558. doi:10.1007/s00192-018-3675-6.
Seracchioli R, et al. Laparoscopic Management of Severe Ureteral Obstruction After Vaginal Hysterectomy and Colposuspension. Int Urogynecol J. 2018;29(10):1557-1558. PubMed PMID: 29855661.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic management of severe ureteral obstruction after vaginal hysterectomy and colposuspension. AU - Seracchioli,Renato, AU - Raimondo,Diego, AU - Salucci,Paolo, AU - Paradisi,Roberto, AU - Mabrouk,Mohamed, Y1 - 2018/05/31/ PY - 2018/03/06/received PY - 2018/05/15/accepted PY - 2018/6/2/pubmed PY - 2019/2/13/medline PY - 2018/6/2/entrez KW - Colposuspension KW - Laparoscopy KW - Ureteral obstruction SP - 1557 EP - 1558 JF - International urogynecology journal JO - Int Urogynecol J VL - 29 IS - 10 N2 - INTRODUCTION AND HYPOTHESIS: After vaginal hysterectomy, uterosacral ligaments are commonly used to suspend the vaginal vault in order to prevent and to treat recurrence of central prolapse. Shull et al. proposed a technique to fix endopelvic fascia and vagina to the higher portion of the uterosacral ligaments using a vaginal approach [1]. This technique is associated with a risk of ureteral obstruction (0-11%) [2, 3]. Although intraoperative cystoscopy is recommended to check ureteral patency at the end of colposuspension, this secondary prevention technique could be false negative due to partial stenosis [4]. METHODS: A 60-year-old woman with stage 3 uterine and anterior compartment descensus assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system underwent vaginal hysterectomy, bilateral adnexectomy, and vaginal vault suspension to the uterosacral ligaments using the Shull technique. Intraoperative cystoscopy with indigo carmine was negative. On postoperative day 0, the patient complained left flank pain. Transabdominal ultrasound showed a left hydroureteronephrosis without ureteral stones, which was confirmed by uro-computed tomography scan. The attempts of ureteral stent positioning and opening the vaginal vault failed to resolve the ureteral obstruction, which was corrected, and a new vault suspension performed using the laparoscopic approach. Prophylactic ureteral stent positioning was performed. Informed consent was obtained from the patient for publication of this case report. RESULTS: The patient was discharged on postoperative day 5 with normal renal function. The ureteral stent was removed after 1 month, and renal ultrasound at 3 and 6 months' follow-up showed normal renal pelvis caliber. No recurrence of genital prolapse was observed at gynecological examination. CONCLUSIONS: Laparoscopy can be a wise alternative option to manage ureteral obstruction secondary to vaginal colposuspension for genital organ prolapse. SN - 1433-3023 UR - https://www.unboundmedicine.com/medline/citation/29855661/Laparoscopic_management_of_severe_ureteral_obstruction_after_vaginal_hysterectomy_and_colposuspension L2 - https://dx.doi.org/10.1007/s00192-018-3675-6 DB - PRIME DP - Unbound Medicine ER -