Ureteral anomalies in gynecologic surgery
A 30-year-old woman with recurrent endometriosis presents for definitive surgical management with a hysterectomy. Her surgical history includes four laparoscopic excisions of endometriosis including bilateral ovarian cystectomies and an appendectomy. Given her surgical history, the retroperitoneum was opened to definitively identify the course of her ureters. Exploration of the right retroperitoneum revealed two right ureters which fused two centimeters proximal to the ureterovesicular junction (Figure 1, Figure 2).
ConclusionUreteral endometriosis can lead to severe consequences, the surgical treatment can be difficult and most of the times incomplete. This video is a detailed example of our team strategy to perform a termino-terminal ureteral laparoscopic anastomosis in a structured way.
We present the case of a 29 year-old G0 with a past history of ureteral obstruction and hydroureteronephrosis due to deeply infiltrating endometriosis requiring left ureterolysis, complete left parametrectomy, and left salpingo-oophorectomy. She now presents with recurrent pelvic pain and a new right adnexal mass consistent with an endometrioma requiring surgical intervention.
The objectives of our study were to (i) examine the rate of vesico-ureteral injury at benign hysterectomy by surgical approach and (ii) compare the risk of vesico-ureteral injury specifically between minimally-invasive laparoscopic and abdominal hysterectomy on a populational level.DesignRetrospective population-based observational study.SettingThe National Inpatient Sample.Patients501,110 women who underwent hysterectomy for benign gynecological disease from 1/2012-9/2015 were included: total abdominal hysterectomy (TAH, n=284,365 [56.7%]), total laparoscopic hysterectomy (TLH, n=60,410, [12.1%]), abdominal supracerv...
ConclusionThis video shows how deep urinary endometriosis can be performed laparoscopically. Mastering suturing is essential to avoid complications.
This video describes a systematic stepwise approach for complete dissection of ovarian remnant in the setting of a previous ureteral re-implantation.
To identify and highlight preservation of the ureter and hypogastric nerve during excision of superficial endometriosis for the treatment of chronic pelvic pain.
Describe an unusual bilateral ureteral reimplantation due to endometriosis and a flowchart of a conservative decision making.
We present a case of extrinsic urethral endometriosis. We review the peri-operative management with renal function testing, pre-operative imaging and stent placement. The patient had a robotic-assisted ureteroneocystostomy with psoas hitch for her severe disease. The goal of this video is to review peri-operative management of urinary tract endometriosis and to demonstrate the surgical technique of ureterolysis in extrinsic ureteral endometriosis and ureteroneocystostomy with psoas hitch.
This video demonstrates a safe and effective minimally invasive technique for enterolysis, oophorectomy and subsequent ureterolysis in the face of deep infiltrating (DIE) and deep fibrotic endometriosis.
To present a successful remission of hydronephrosis, with laparoscopic surgery of complete excision for DIE lesion, and end-to-end anastomosis of left ureter.