Delayed diagnosis of ureteral obstruction and hydronephrosis despite intraoperative cystoscopy: a case report.
BACKGROUND
Routine intraoperative cystoscopy is often advocated to improve the diagnosis of ureteral obstruction in gynecologic surgery. It is possible for ureteral obstruction to occur in the immediate postoperative period and thus can be missed by cystoscopy.


METHODS
A patient had an anterior vaginal repair and transobturator sling. Intraoperative cystoscopy showed no abnormalities and demonstrated ureteral patency. Subsequently she developed unilateral hydronephrosis. Cystoscopy is advocated in similar cases but is not certain to rule out the occurrence of hydronephrosis in the postoperative period.


CONCLUSIONS
Even if cystoscopy is performed routinely following gynecologic surgery, hydronephrosis is still a possibility, and the diagnosis should not be dismissed out of hand.
Washington
John L
JL
Central Carolina Gynecology and Urogynecology, Burlington, NC 27215, USA. jlw50@bellsouth.net
D000368:Aged; D003558:Cystoscopy; D005188:False Negative Reactions; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D053825:Suburethral Slings; D014517:Ureteral Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery