Ureteral compromise after laparoscopic Burch colpopexy
1Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island, USA.
Summary
Two patients developed ureteral obstruction after laparoscopic Burch cystourethropexy due to misplaced sutures. Prompt diagnosis and surgical release resolved the obstruction and hydronephrosis, highlighting the need for careful suture placement and post-operative cystoscopy.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Gynecologic Surgery
Background:
- Laparoscopic Burch cystourethropexy is a common procedure for treating stress urinary incontinence.
- Potential complications, though rare, require careful consideration and management.
Observation:
- Two patients experienced ureteral obstruction with flank pain and hydronephrosis post-laparoscopic Burch cystourethropexy.
- Cystoscopy revealed sutures had passed transmurally, adjacent to the right ureteral orifice.
Findings:
- Surgical release of the misplaced sutures, via cystoscopy or laparoscopy, led to immediate urine efflux from the ureter.
- Ultrasound confirmed rapid resolution of hydronephrosis following suture release.
Implications:
- Routine post-operative cystoscopy is recommended after retropubic cystourethropexy to ensure ureteral patency.
- Suture placement technique (medial to lateral) may prevent ureteral entrapment.
- Transmural suture passage can cause significant ureteral obstruction requiring intervention.
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