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Hutch paraureteral diverticulum complicating radical hysterectomy
J P Geisler1, J F Dupler, O M Soriero
1Department of Obstetrics and Gynecology, St. Vincent Hospital and Health Care Center, Indianapolis, Indiana, USA.
Background:
Paraureteral diverticula are abnormalities of the urinary bladder which are more common in males, and thus are infrequently encountered in the patient population of the gynecologic oncologist.
Case Report:
A 59 year old white female, with a history of recurrent bladder cancer treated by transurethral resection, presented with an abnormal cervical cone biopsy revealing invasive squamous cell carcinoma of the uterine cervix". The patient had a known Hutch paraureteral diverticulum for which she was receiving prophylactic cyprofloxacin. Computed tomography revealed an 8.5 x 8 x 7 cm paraureteral diverticulum on the right. There was no hydronephrosis of either renal pelvis. Laparotomy revealed a mass, resembling a second urinary bladder, which was very closely associated with the bladder and lateral proximal vagina on the right. Since a urological consultant advised that the diverticulum should not be resected, dissection around the bladder and vagina for the radical hysterectomy was made much more difficult.
Conclusion:
The presence of a paraureteral diverticulum increases the difficulty of performing a radical hysterectomy.