Jennifer Schmitt, DO, Bradford Fenton, MD, PhD
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota (Dr. Schmitt). Department of Obstetrics and Gynecology, SUMMA Health Systems, Akron, Ohio (both authors).
Introduction: Hysterectomies are the second most common major surgical procedure among women in their reproductive years. Ureteral injury is a known complication of this surgery. Intraoperative cystoscopy is not yet used routinely to evaluate the ureteral function before concluding a benign hysterectomy.
Case Description: A 40-year-old woman had a laparoscopy-assisted vaginal hysterectomy with intraoperative cystoscopy that noted unilateral absence of ureteral dye spill. Urology was consulted and diagnosed an incidental, complete, obstructing kidney stone in the ureter, which was removed and stented during an exploratory laparotomy.
Conclusion: Although the chance of ureteral obstruction secondary to a kidney stone is small, either during or after gynecologic surgery, this case suggests that it should remain on the list of differential diagnoses.
Key Words: Cystoscopy, Hysterectomy, Kidney stone, Laparoscopy, Ureteral obstruction.