title: A delayed type of ureteric injury developed after transobturator mesh procedure for massive prolapse.
abstract: We report on a rare case of delayed presentation of ureteric injury with a transobturator mesh kit for anterior vaginal wall prolapse repair along with conventional vaginal pelvic reconstructive surgery: a case of a 56-year-old multiparous, postmenopausal woman with a body mass index of 22.1 kg/m, who had continuous leakage of urine per vagina 28 days after vaginal hysterectomy, mesh-augmented anterior repair with Avaulta Plus Anterior support system kit (CR Bard Inc, Covington, Ga), and sacrospinous ligament fixation for stage IV pelvic organ prolapse. Pelvic computed tomographic scan with contrast revealed an intact bladder, right hydroureteronephrosis, and right ureterovaginal fistula. Immediate laparotomy performed revealed that the right lower mesh arm was entangled with the distal end of the right ureter, 1.5 cm from the ureteric orifice. Category, time, site classification was 4CaT2S5. Right ureteric reimplantation was performed uneventfully. We herein emphasize that the development of a delayed type of ureteric injury is a possible associated complication of transobturator mesh surgery for the prolapse.
authors.affiliation: Division of Urogynaecology, Department of Obstetrics & Gynaecology, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
authors.forename: Anil Krishna
authors.initials: AK
authors.lastname: Dass
authors.forename: Tsia-Shu
authors.initials: TS
authors.lastname: Lo
authors.forename: Siwatchaya
authors.initials: S
authors.lastname: Khanuengkitkong
authors.forename: Yiap Loong
authors.initials: YL
authors.lastname: Tan
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D013526:Surgical Mesh / Q000009:adverse effects*; D013997:Time Factors; D014513:Ureter / Q000293:injuries*