Endoscopic balloon dilation in the management of ureteral stricture after urogynecologic surgery: a case report.

BACKGROUND: Ureteral injuries are known complications of urogynecologic surgery. Until now, ureteral reimplantation with laparotomy has been used in cases in which ureteral stenting of distal obstruction was unsuccessful. CASE: We report a case of a 74-year-old woman with a recognized right ureteral injury after vaginal reconstructive surgery that failed ureteral stenting to relieve the obstruction and who presented with ureteral stricture and mild hydronephrosis 6 weeks postoperatively. Ureteroscopy with endoscopic balloon dilation reduced the stricture successfully. The patient remains asymptomatic, with normal renal sonogram, 6 months after the procedure. CONCLUSION: Endoscopic balloon dilation is an effective technique that can be used for the management of ureteral strictures after urogynecologic surgery and avoids further surgical intervention.

[Endometriosis: an essential differential diagnosis of chronic pelvic pain]. / Place de l'endométriose dans le diagnostic différentiel des douleurs pelviennes chroniques.

In the context of chronic pelvic pain, endometriosis plays a significant role due to its frequency and its effects on the quality of women's lives. It affects 3-10% of women of reproductive age. The clinical signs are part from chronic pelvic pain, dysmenorrhea, dyspareunia, urinary and digestive symptoms as well as infertility. The clinical signs and symptoms may vary and the clinical examination may be difficult to interpret for a physician who is not familiar with the condition. This explains the fact that it takes more time to make the diagnosis of endometriosis. Delay of diagnosis, multiple consultations and complex surgical procedures implicate physical and psychological suffering for the patient with serious complications. For all these reasons, the differential diagnosis of chronic pelvic pain in women should include endometriosis.

A case of a large rectovaginal mass presenting as posterior vaginal wall prolapse.

A 66-year-old female presented with symptoms suggestive of pelvic organ prolapse, history of fibroid uterus, and rectal pressure. Pelvic examination revealed a large pelvic mass filling the posterior cul-de-sac, occupying the rectovaginal septum, and compressing the rectum. There was a stage II pelvic organ prolapse of the posterior vaginal wall with distal vaginal wall extending to the hymen during valsalva. A CT scan confirmed the large pelvic mass distinct from the uterus measuring 9.4 × 9.8 × 6.2 cm. Colorectal workup revealed adenocarcinoma of colon on screening colonoscopy with biopsies. Patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, colon resection, and abdominal resection of the pelvic mass in the rectovaginal septum and inferior to the uterus. The patient did not require any concomitant pelvic reconstruction and the posterior vaginal wall prolapse resolved after resecting the pelvic mass.

Variant iliocaval confluence discovered during sacrocolpopexy.

BACKGROUND: Laceration of the iliac veins and their branches is a feared complication in abdominal sacral colpopexy. Hemorrhages can be extensive and difficult to control. CASE: We report a case of a patient who, while undergoing abdominal sacral colpopexy, was found to have confluence of the iliac veins at the level of the second sacral vertebra instead of the expected fourth lumbar to first sacral vertebral bodies. The intraoperative course had to be revised because of the increased risk of bleeding. The patient tolerated the procedure well and without any complications. CONCLUSION: With pelvic reconstructive surgery becoming more commonplace, knowledge of possible anomalous vessels is important because modification of planned surgical approach may be necessary to avoid short-term and long-term complications.