You are on page 1of 2

Incont Pelvic Floor Dysfunct 2010; 4(4):119-120 Clinical pearls Genitourinary tract image

Kinking of the Lower Ureter Is this a Sign of Suspected Concomitant


Ureteral Injury with Vesico-vaginal Fistula?
Yu-Wei Chou, M.D., Po-Jen Hsiao, M.D., Shang-Hsing Lee, M.D., Han-Sun Chiang, M.D., Chun-Hou Liao, M.D.
Division of Urology, Department of Surgery, Cardinal Tien Hospital and Fu-Jen Catholic University, Taipei, Taiwan; E-mail: liaoch22@gmail.com

fkqolar`qflk

f==I=~=~=~=~=~=
==~===~==
==xNJRzK=c~=~=~~====
~=~==~=~===~=~
~===~=xSzK=q=====
~=~=~=~=~===~=~~
==~~=~=~===~=K=^
~=~==~~==~=I==
I===~=~==~=~===~==xQI
RzK
`==~=~=~==~==~=~
===~K=^=~==~====J
=~==~=~=EomF==~==xQJ
TzK=t==~=~=J~~=~==~=~=~=~
~~===~=K=q==~=~=J
===~K

`^pb=mobpbkq^qflk

^=QS=~J=~=~=~===~~~=~=~~ Fig. 1. Excretory urography showed kinking of right lower ureter with no
K=p==~~=~=~~== signs of obstruction or contrast medium extravasation.
=~=~==~K=^~==~=J
====~K=^=~~=uJ~=
====I=~==~=~==~=~
K
eI==~=~~===~~=~=
==~=~K=b=~=~=~=J
===~~=~=~=~=J~~=~=~
K=h======~=~===
=====~==~~~=EcK=NFK=^
~=~=====~=~==~=K
`~=~=~=J=~=~=~===J
=~===~=~=~==~=~
~~==~====~~=~=EcK=OFK
^====~====~===J
=~~~I====g==~=~~
~==~=~K=r~I===~==
===~==~==~~~=
~=~=~=~=K=f~J~I=~==~J
=~=====~==~==J
=~========
==K=c=~=~=~==~=~J
=K=q=~=~==~=~====~J
~====c=~=~====~ Fig. 2. Cystography revealed a wide-open fistula tract at the midline postero-
~K superior surface of the bladder cavity and significant passage of con-
trast medium into the vaginal space.
NNV
Clinical pearls Genitourinary tract image

afp`rppflk ~~I=~~I=~==~~=xNJQzK=q=~~
====~=~I==~==~I
sJ~~=~=~====~==J ~==I=~=~=K=i~~=~==~J
~=~=~===I=~=~~=TRB=~ =~~=~==~==xNNINOzI===~=
===xNJRzK=k~~I=~~=J ====~=K
=~==~=~=~=~===~ q===~=~=====~=~
K=eI====~=~====~ ===I====~I===~=~=
~~==~==~~= I=~====~~=~==~=K
xUIVzK=p=vh=xNMz=====~=~==~ o~====~==~=~=J
~~J~=~~==~=QKVLNMMM= =~==~=~=K=q~=~==
~= = = = PKVLNMMM= = ~= ~= = ~ =~=~===~====~K
NKMLNMMM==~=K=m=~~==~===J q====~======~=K
==~=~~==~=K r~I==E[SRBF=~===~=
j=~=~==~==~=~= ~=~=~I======~=I==
I===~==~==~===K =~I===I=~=~==~=
q======~=~=~ =~=~=xRzK
~=~===~=~~===~~=~=J f=~I=~======~==~J
~===~=K=q==~===~ =J~~=~=xNIOzK=^===~=~J
=====~=~=~I=== ~===~====~~==om=
=~I===I=~=~~I=J ====~=~=~==K=q
====~=~I=LI==~= ~~~=~~==J~~=~=~===~J
~~=~I=~=I=~=~==J~ ===~====~K
I=~=~=~=xRzK=^=~=~==~==J
~=~=~=~=~=~===~I= obcbobk`bp
=~=~~=~=~=~==~=~==~=J
~===~=~=K 1. Goodwin WE, Scardino PT: Vesicovaginal and ureterovaginal
q=====MKRB==OB==~==~=J fistulas: A summary of 25 years of experience. J Urol 1980; 123:
=~==~=~==NMB==~~=J 370-374.
2. Lee RA, Symmonds RE, Williams TJ: Current status of genitouri-
=xRzK=d==~=xNz==~=~=~=
nary fistula. Obstet Gynecol 1988; 72:313-319.
~=~~==~=J~~=~====NMB= 3. Tancer ML: Observations on prevention and management of vesi-
~K=^==~====~= covaginal fistula after total hysterectomy. Surg Gynecol Obstet 1992;
=====J~~=~I===~~= 175:501-506.
=~=~=~~=~==~= 4. Smith GL, Williams G: Vesicovaginal fistula. BJU Int 1999; 83:564-
=~~==K=q=~~=~=~=~~~J 569; quiz 569-570.
==~=~I=====I=~ 5. Brandes S, Coburn M, Armenakas N, et al: Diagnosis and manage-
ment of ureteric injury: An evidence-based analysis. BJU Int 2004;
~===~~=~K=q===~==
94:277-289.
=~==~~=~~=~=~===~=xTzK=f 6. Thomas K, Williams G: Medicolegal aspects of vesicovaginal fistulae.
=~=~=~====~=~~==J BJU Int 2000; 86:354-359.
=~===~===I=om===~~= 7. Yu NC, Raman SS, Patel M, Barbaric Z: Fistulas of the genitouri-
=~=~~=======~J nary tract: A radiologic review. Radiographics 2004; 24:1331-1352.
.. ..
~=~=====~==J~~=~=J 8. Hakki-Siren P, Sjoberg J, Tiitinen A: Urinary tract injuries after
~~=~=xQzK hysterectomy. Obstet Gynecol 1998; 92:113-138.
..
9. Parpala-Sprman T, Paananen I, Santala M, Ohtonen P, Hellstrom
f==~I==~====~
P: Increasing numbers of ureteric injuries after the introduction of
==~==~~~K=eI==J laparoscopic surgery. Scand J Urol Nephrol 2008; 42:422-427.
=~=====~==~= 10. Soong YK, Yu HT, Wang CJ, Lee CL, Huang HY: Urinary tract in-
~==~===~===~K=m~J jury in laparoscopic-assisted vaginal hysterectomy. J Minim Inva-
=om=~~==~=I===~=~==J sive Gynecol 2007; 14:600-605.
..
=~=~=~~K=t=~====J 11. Gozen AS, Teber D, Canda AE, Rassweiler J: Transperitoneal
~===========I=~ laparoscopic repair of iatrogenic vesicovaginal fistulas: Heilbronn
experience and review of the literature. J Endourol 2009; 23:475-
======g===
479.
~=~K 12. Sotelo R, Mariano MB, Garca-Segui A, et al: Laparoscopic repair
q=~=~~===J~~=~= of vesicovaginal fistula. J Urol 2005; 173:1615-1618.

NOM

You might also like