1. Repair ureter injury after cesarean section via trans- illumination of ureteroscope : A case report
楊政達1、何宗錦1、陳丕哲2
Cheng-Ta Yang1, Tsung-Chin Ho1, Pi-Che Chen2
1戴德森醫療財團法人嘉義基督教醫院 婦產部、2泌尿科
1Department of Obstetrics and Gynecology, 2Department of Urology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
Introduction: Ureter injury is an uncommon complication of cesarean section. As with all iatrogenic ureter injuries, if the problem is not recognized intraoperatively, the manifestations may be protean. The management of ureter injury that is first recognized in the early postoperative period must be individualized. We present a case of ureteral injury during a cesarean section.
Brief history: The 30 years old woman, G2P2, was referred from local obstetric clinic just a few hours after cesarean section. Review her history, she was operated due to previous cesarean section. She developed intractable right flank soreness a few hours after the operation. She had an ultrasound scan which confirmed a unilateral hydronephrosis on the right side. So, she was transferred to our hospital.
IVP revealed obstruction at the right distal ureter. Laparotomy via previous wound was done. It’s difficult to identify injury site due to severe tissue edema. So urologist was called for help. Ureteroscopy was done and the injury site was easily identified via trans- illumination of ureteroscope. The ureter was sutured with hysterotomy wound. The stitches were removed and hysterotomy wound was resutured. She recovered smoothly and discharged 5 days later.
Discussion: Ureter injury is a rare complication of cesarean section. The incidence was 0.09% to 0.3%. It is attributable most often to ureteral transaction or ligation associated with uterine incision extensions in the lower uterine segment , and to attempts to achieve hemostasis. The intraoperative diagnosis of ureteric injury is very difficult. Key factors to obtain optimal results in the management of ureter injury are the early recognition and immediate repair of damage. This patient was diagnosed early. The obstruction was identified via trans- illumination of ureteroscope and repaied by dissecting the ureter and releasing offending sutures that were angulating the ureter and occluding the lumens. She recovered without sequela.