Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota (Dr. Schmitt). Department of Obstetrics and Gynecology, SUMMA Health Systems, Akron, Ohio (both authors).

ABSTRACT

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.

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Department of Urology, Toyama City Hospital, Toyama, Japan (all authors).

ABSTRACT

Introduction: Retroperitoneoscopic laparoendoscopic single-site surgery for congenital midureteral stricture was performed in a nulliparous girl with contralateral multicystic dysplastic kidney.

Case Description: The patient presented with a 4-year history of intermittent right flank pain and 3 episodes of right acute pyelonephritis. A right-sided retrograde ureteropyelogram showed a short and narrow stricture at the level of L5 with proximal hydroureteronephrosis. Ureterolysis and ureteroplasty were successfully performed via the retroperitoneal route. The total operation time was 200 minutes, and the estimated blood loss was 10 mL. The patient was discharged on postoperative day 5 with no complications. At the 12-month follow-up, the patient reported complete relief from pain and intravenous pyelography showed markedly decreased hydroureteronephrosis.

Discussion: Retroperitoneoscopic laparoendoscopic single-site surgery is an effective treatment option for congenital midureteral stricture with an acceptable esthetic outcome and minimal morbidity.

Key Words: Ureteral obstruction, Midureteral stricture, Laparoendoscopic single-site surgery, Retroperitoneoscopy, Multicystic dysplastic kidney disease.

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