[The gynecologic ureter revisited]

From 1991 to 2001, 23 female patients were admitted to the Urologic Operative Unit of the Varese Hospital for urological lesions due to gynecological surgery. The mean age of the patients was 52 years. Out of them, 5 presented a complete division of the ureter after hysterectomy, 3 an inadvertently ligature of the ureter and 2 an angulation. In 12 cases a vesico-vaginal fistula was present, while a patient presented an uretero-vaginal fistula. The 5 patients with complete division of the ureter underwent: end-to-end anastomosis (3 patients); reimplantation (2 patients); psoas hitch (1 patient). In 3 patients with ureter ligation a reimplantation with psoas hitch was performed; in 2 cases with ureter angulation a double J stent was placed. The patient with an uretero-vaginal fistula underwent a reimplantation with psoas hitch while the patients with vesico-vaginal fistula were successfully treated by a combined transperitoneal and transvesical access, excision of the fistula tract and closure of the bladder and vaginal wall with omental interposition.