Iatrogenic ureterovaginal fistula after laparoscopic hysterectomy: a case report

Introduction
The highest risk of intraoperative ureteral trauma is associated with hysterectomy, performed most frequently in postmenopausal women. The overall incidence of ureteral injuries varies in different studies between 0.5 and 10%.

Case report
Ureterovaginal fistula following laparoscopic subtotal hysterectomy with bilateral salpingoophorectomy is reported in this case. Ureteral injury was not noticed during operation. Two weeks after the operation the patient noticed constant urine leakage from the vagina.

Discussion
A computed tomography scan revealed dilation of the left renal pelvis and the upper two thirds of the ureter due to an inflammatory fibrous mass with air bubbles involving its lower part. Contrast medium outflow identified the site of urine leakage. Subsequently, diagnostic cystoscopy and ureteroscopy revealed a fistula between the ureter and the apex of the vagina. The patient developed an iatrogenic ureterovaginal fistula, which was repaired successfully with a ureteroneocystostomy over a double-J stent a month and a half later. At the follow-up 3 months post operation there was no urine leakage from the vagina, no hydronephrosis in ultrasound check-up or ureterovaginal fistula on vaginal examination.

Conclusions
This paper highlights the problem of unnoticed ureteral injury during gynaecological surgeries, which, if overlooked, can develop into severe complications. Causes of ureteral injuries, prevention, and possible treatment options are also discussed.