Laparoscopic management of severe ureteral obstruction after vaginal hysterectomy and colposuspension

After vaginal hysterectomy, uterosacral ligaments are commonly used to suspend the vaginal vault in order to prevent and to treat recurrence of central prolapse. Shull et al. proposed a technique to fix endopelvic fascia and vagina to the higher portion of the uterosacral ligaments using a vaginal approach [1]. This technique is associated with a risk of ureteral obstruction (0–11%) [2, 3]. Although intraoperative cystoscopy is recommended to check ureteral patency at the end of colposuspension, this secondary prevention technique could be false negative due to partial stenosis [4].

A 60-year-old woman with stage 3 uterine and anterior compartment descensus assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system underwent vaginal hysterectomy, bilateral adnexectomy, and vaginal vault suspension to the uterosacral ligaments using the Shull technique. Intraoperative cystoscopy with indigo carmine was negative. On postoperative day 0, the patient complained left flank pain. Transabdominal ultrasound showed a left hydroureteronephrosis without ureteral stones, which was confirmed by uro-computed tomography scan. The attempts of ureteral stent positioning and opening the vaginal vault failed to resolve the ureteral obstruction, which was corrected, and a new vault suspension performed using the laparoscopic approach. Prophylactic ureteral stent positioning was performed. Informed consent was obtained from the patient for publication of this case report.

The patient was discharged on postoperative day 5 with normal renal function. The ureteral stent was removed after 1 month, and renal ultrasound at 3 and 6 months’ follow-up showed normal renal pelvis caliber. No recurrence of genital prolapse was observed at gynecological examination.

Laparoscopy can be a wise alternative option to manage ureteral obstruction secondary to vaginal colposuspension for genital organ prolapse.