Transvaginal repair for ureteral injuries caused by sutures: A case report
Jimiao Huang1,2, Yan Lin1, Junfeng Li1
1Department of Gynecologic Oncology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China.
Rationale:
Ureteral injury from sutures during total hysterectomy is a relatively uncommon but potentially severe complication that can lead to serious sequelae such as ureterovaginal fistula or renal insufficiency. The management of such injuries remains challenging, and there is a need for effective and minimally invasive approaches to mitigate complications and enhance patient recovery. This study aims to introduce a novel minimally invasive alternative - transvaginal suture removal and ureteral stenting under local anesthesia - and to evaluate its efficacy in reducing complications and improving patient outcomes.
Patient Concerns:
A 49-year-old female experienced mild lumbar pain on the fourth day after total laparoscopic hysterectomy for uterine fibroids and adenomyosis. She had no prior kidney issues but developed postoperative right low back pain, microscopic hematuria, and ultrasound evidence of right hydronephrosis and ureteral dilation.
Diagnoses:
The patient was diagnosed with iatrogenic ureteral injury due to sutures, confirmed by ultrasound and surgical video review showing the right ureter partially sutured to the vaginal stump.
Interventions:
We performed transvaginal suture removal and ureteral stenting under local anesthesia. This minimally invasive approach avoided general anesthesia and secondary laparoscopic surgery.
Outcomes:
The procedure was successful, with smooth suture removal and stent implantation. The patient's symptoms significantly improved on the second postoperative day. Follow-up at 1 month revealed no discomfort, and the ureteral stent was removed 3 months later.
Lessons:
This case highlights transvaginal suture removal as a novel, minimally invasive treatment for iatrogenic lower ureteral injuries. This approach may be performed by gynecologists under local anesthesia, potentially preventing severe complications and reducing patient discomfort and costs.
