title: Ureteral injury after transvaginal ultrasound-guided oocyte retrieval: a complication of in vitro fertilization-embryo transfer that may lurk undetected in women presenting with severe ovarian hyperstimulation syndrome.
abstract: OBJECTIVE
  To report a case of ureteral injury after transvaginal ultrasound-guided oocyte retrieval, initially misdiagnosed as an ovarian hyperstimulation syndrome (OHSS).
  
  
  METHODS
  Case report.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A 26-year-old patient with a history of primary infertility due to polycystic ovary syndrome (PCOS) presented with acute pelvic pain after transvaginal ultrasound-guided oocyte retrieval for in vitro fertilization-embryo transfer.
  
  
  METHODS
  Initial clinical presentation, context, and imaging results were consistent with the diagnosis of mild OHSS. Recurrence of the pelvic pain with radiation to the right lumbar region suggested the possibility of a urinary complication.
  
  
  METHODS
  Successful detection and management of unilateral ureteral injury in a patient with PCOS.
  
  
  RESULTS
  Uro-computed tomography scan helped with the diagnosis of right pelvic-ureter lesion. Patient underwent cystoscopy with uncomplicated right ureteral stent placement and delivered a healthy baby at term.
  
  
  CONCLUSIONS
  Although ureteral injury after transvaginal ultrasound-guided oocyte retrieval is a rare complication of IVF-ET, it could have serious sequelae such as fistula formation and renal dysfunction if untreated. Clinicians must be aware that it may lurk undetected in women presenting OHSS.
authors.affiliation: AP-HP, Service de Gynécologie-Obstétrique et Médecine de Reproduction, Hôpital Antoine Béclère, Clamart, France. michael.grynberg@abc.aphp.fr
authors.forename: Michaël
authors.initials: M
authors.lastname: Grynberg
authors.forename: Ana Luiza
authors.initials: AL
authors.lastname: Berwanger
authors.forename: Meryl
authors.initials: M
authors.lastname: Toledano
authors.forename: Rene
authors.initials: R
authors.lastname: Frydman
authors.forename: Xavier
authors.initials: X
authors.lastname: Deffieux
authors.forename: Renato
authors.initials: R
authors.lastname: Fanchin
mesh_terms: D000328:Adult; D004624:Embryo Transfer / Q000009:adverse effects*; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects*; D006801:Humans; D054315:Oocyte Retrieval / Q000009:adverse effects*; D016471:Ovarian Hyperstimulation Syndrome / Q000175:diagnosis / Q000628:therapy*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional / Q000009:adverse effects*; D014513:Ureter / Q000293:injuries*