Transection of Duplex Ureter During Vaginal Hysterectomy

Abstract

Duplex ureter, an embryological developmental anomaly, can lead to intra-operative injuries, even by surgeons with a stronghold on normal ureteric anatomy. We describe the first case of an ectopic ureter transected during vaginal hysterectomy performed for pelvic organ proplase, due to its abnormally low implantation into the bladder, worsened by cystocoele. The injury was recognised, and the duplex ureter was diagnosed with cystoscopy and retrograde pyelography. A post-operative computed tomography urogram allowed us to map the exact course. In this case, there was injury to the ectopic, non-functional ureter, thus averting any further intervention. However, lower urinary tract injuries are serious complications with high morbidity, especially during delayed diagnosis. Knowledge of the ureter variants, meticulous tracing of the course, and use of post-operative cystoscopy could reduce these complications, particularly in face of increasing minimally invasive approaches.

Pelvic Lymphadenectomy in Gynecologic Oncology—Significance of Anatomical Variations

“…Anatomical variations of the ureter are often associated with other congenital anomalies. Patients with known congenital anomalies or different types of syndromes should undergo preoperative imaging for careful surgical planning [ 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Postoperatively, a routine cystoscopy should be performed to rule out UIs [ 26 ].…”

Cambios en el perfil y manejo de los traumatismos genitourinarios en un área de salud estándar

“…En el caso particular de la cirugía ginecológica, son factores de riesgo el tamaño del útero, la presencia de quistes ováricos grandes o la endometriosis observando Grainger y col. en 1990 como un gran porcentaje de lesiones ureterales se producían tras la lisis electroquirúrgica o con láser de la endometriosis (16). Dentro de las alteraciones anatómicas se encuentra la duplicidad ureteral que se trata de una de las anomalías congénitas del tracto urinario más frecuente con una incidencia de 1:125 nacidos vivos que puede provocar lesiones ureterales intraoperatorias incluso en manos de cirujanos expertos en anatomía ureteral como en el caso clínico presentado por Amenda por lo que se requiere un estudio adecuado mediante diferentes técnicas diagnósticas tales como cistoscopia, pielografía retrógrada o UROTAC ante la sospecha de sistemas ureterales complejos para la planificación de la cirugía (159). Dentro de la yatrogenia también juega un papel el propio escenario urológico con la ureteroscopia.…”