title: Ureteroscopy: savior to the gynecologist? Ureteroscopic management of post laparoscopic-assisted vaginal hysterectomy ureterovaginal fistulas.
abstract: Iatrogenic ureteral injuries are among the most serious complications in gynecologic surgery. With the increasing popularity of laparoscopic gynecologic surgery, the incidence of ureteral injuries is on the rise. We report 2 cases of post laparoscopic-assisted vaginal hysterectomy (post LAVH) ureterovaginal fistulas, which were managed successfully with retrograde stenting using ureteroscopy. Three middle-aged women who underwent LAVH for symptomatic myomas of the uterus presented with ureterovaginal fistulas in the late postoperative period. Excretory urography revealed ureterovaginal fistulas involving the distal ureter. Retrograde stenting was possible in 2 patients, using a 7.5F rigid ureteroscope. Both patients became continent 2 days after surgery. Urography at 6 weeks revealed normal renal function without obstruction or extravasation of urine, and the stents were removed. Stenting failed in the third patient; the patient underwent a ureteric reimplantation successfully. Post LAVH ureterovaginal fistulas are amenable to ureteroscopic retrograde double-J stenting, which enables spontaneous recovery of the injured ureter. An attempt of ureteroscopic stenting should be considered in all patients with post LAVH ureterovaginal fistulas before subjecting them to other modalities.
authors.affiliation: Department of Urology, Army Hospital, Delhi Cantt, Delhi, India. drvineetnarang@hotmail.com
authors.forename: Vineet
authors.initials: V
authors.lastname: Narang
authors.forename: Tapan
authors.initials: T
authors.lastname: Sinha
authors.forename: Shailash C
authors.initials: SC
authors.lastname: Karan
authors.forename: Arjun Singh
authors.initials: AS
authors.lastname: Sandhu
authors.forename: Gurwinder Singh
authors.initials: GS
authors.lastname: Sethi
authors.forename: Anand
authors.initials: A
authors.lastname: Srivastava
authors.forename: Raghav
authors.initials: R
authors.lastname: Talwar
authors.forename: Nirupam
authors.initials: N
authors.lastname: Adlakha
mesh_terms: D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects*; D007049:Iatrogenic Disease; D010535:Laparoscopy / Q000009:adverse effects; D007889:Leiomyoma / Q000601:surgery; D008875:Middle Aged; D015607:Stents; D014513:Ureter / Q000293:injuries / Q000601:surgery; D014515:Ureteral Diseases / Q000209:etiology / Q000601:surgery*; D018666:Ureteroscopy; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery*; D014594:Uterine Neoplasms / Q000601:surgery; D014624:Vaginal Fistula / Q000209:etiology / Q000601:surgery*