Transvaginal Excision of Bilateral Single Ureteral Stumps of Refluxing Ectopic Ureters in an Adult Female with Urinary Incontinence

Bilal Farhan, Zhamshid Okhunov, Adam Kaplan, Gamal Ghoniem

Research output: Contribution to journalArticle

Abstract

Objective To report a novel surgical technique of transvaginal excision of bilateral refluxing single ureteral stumps in an adult female, with emphasis on the technique, the difficulties of the procedure, and other surgical consideration such as bladder neck reconstruction and use of pubovaginal sling in patients with these congenital anomalies. Methods The procedure starts with cystoscopy for identification and catheterization of the orifices of remnant ectopic ureters. This is important to facilitate close dissection of ureteral stumps without the risk of vascular and visceral injury. A wide inverted U incision is made in the anterior vaginal wall to complete the dissection and excision for the remnants of ectopic ureters followed by water-tight closure for each ureterourethral junction. The procedure is completed with bladder neck reconstruction and pubovaginal sling with autologous rectus fascia. Results The operative time was 3 hours, estimated blood loss was 50 mL, and hospital stay was 1 day. There were no intraoperative complications, and the patient went home on catheter drainage for 10 days with prophylactic antibiotics and anticholinergic medications. One-year follow-up showed her global satisfaction of 80%, and she uses one small pad per day as needed. She reported no more recurrent urinary tract infections, no difficulty of voiding, and no pain. Conclusion Transvaginal approach for excision of bilateral infravesical remnant of ectopic ureters in an adult female is feasible. Successful surgical outcomes require bladder neck reconstruction and use of autologous rectus fascia in patient with bilateral single-system ectopic ureters, as the sphincteric mechanism of the bladder neck is absent.

Original languageEnglish (US)
Pages (from-to)192-195
Number of pages4
JournalUrology
Volume86
Issue number1
DOIs
StatePublished - Jul 1 2015
Externally publishedYes

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Urinary Incontinence
Ureter
Urinary Bladder
Fascia
Dissection
Cystoscopy
Vascular System Injuries
Intraoperative Complications
Cholinergic Antagonists
Operative Time
Urinary Tract Infections
Catheterization
Drainage
Length of Stay
Catheters
Anti-Bacterial Agents
Pain
Water

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Transvaginal Excision of Bilateral Single Ureteral Stumps of Refluxing Ectopic Ureters in an Adult Female with Urinary Incontinence. / Farhan, Bilal; Okhunov, Zhamshid; Kaplan, Adam; Ghoniem, Gamal.

In: Urology, Vol. 86, No. 1, 01.07.2015, p. 192-195.

Research output: Contribution to journalArticle

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abstract = "Objective To report a novel surgical technique of transvaginal excision of bilateral refluxing single ureteral stumps in an adult female, with emphasis on the technique, the difficulties of the procedure, and other surgical consideration such as bladder neck reconstruction and use of pubovaginal sling in patients with these congenital anomalies. Methods The procedure starts with cystoscopy for identification and catheterization of the orifices of remnant ectopic ureters. This is important to facilitate close dissection of ureteral stumps without the risk of vascular and visceral injury. A wide inverted U incision is made in the anterior vaginal wall to complete the dissection and excision for the remnants of ectopic ureters followed by water-tight closure for each ureterourethral junction. The procedure is completed with bladder neck reconstruction and pubovaginal sling with autologous rectus fascia. Results The operative time was 3 hours, estimated blood loss was 50 mL, and hospital stay was 1 day. There were no intraoperative complications, and the patient went home on catheter drainage for 10 days with prophylactic antibiotics and anticholinergic medications. One-year follow-up showed her global satisfaction of 80{\%}, and she uses one small pad per day as needed. She reported no more recurrent urinary tract infections, no difficulty of voiding, and no pain. Conclusion Transvaginal approach for excision of bilateral infravesical remnant of ectopic ureters in an adult female is feasible. Successful surgical outcomes require bladder neck reconstruction and use of autologous rectus fascia in patient with bilateral single-system ectopic ureters, as the sphincteric mechanism of the bladder neck is absent.",
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