Iris Publishers_World Journal of Gynecology & Womens Health

Ureteral Stenosis after Uterine Suspension Using TVM (Transvaginal Mesh)

Introduction

We report a rare case of ureteral stenosis after sacrospinous suspension. A 64-year-old post-menopausal female, G2P2, complained of a heavy sensation and the feeling of sitting on a ball, especially in the afternoon. Tracing back her previous surgical history, she had undergone a cesarean section and subtotal hysterectomy due to myoma with severe adhesion. A pelvic examination revealed total prolapse of the vaginal cervix with stage III cystocele. A urodynamic study revealed bladder outlet obstruction, and a pad test was 13g after restoring the vaginal cervix. Therefore, after explaining the risks and complications of surgery, Pelvic organ prolapse (POP) surgery including sacrospinous suspension (Upholds), mid-urethral sling surgery (Solyx) and anterior compartment repair was performed. Ten days after surgery, she returned to our hospital due to left costovertebral angle pain plus knocking tenderness. CT showed hydronephrosis without urolithiasis, and antegrade pyelography also showed ureteral stenosis in the lower third (Figure 1). After several attempts at stent insertion had failed, a urologist suggested re-implanting the ureter. The postoperative course was uneventful. Intravenous pyelography was performed 4 months after this surgery, and showed a patent left ureter.

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