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Query: UMLS:C0403608 (ureter)
 9,655 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bladder and ureteral injuries are associated with several types of hysterectomies performed laparoscopically. Subtotal hysterectomy is said to cause fewer complications and provide better pelvic support by preserving the uterosacral and cardinal ligaments, but there are also arguments against it. A new technique, total laparoscopic intrafascial hysterectomy (TLIH) has all the benefits of total and subtotal hysterectomies, but fewer complications. Conventionally, uterosacral ligaments are cut at or just below their junction with the cervix, and the remaining vagina and cardinal ligaments are cut at the same level. With TLIH, using a uterine manipulator and colpotomizer, the incision is made at a much higher level. The cervix is circumcised while preserving the entire uterosacral and cardinal ligaments and full length of the vagina, except in cases of malignancy or severe pelvic endometriosis. The ureter is mobilized farther from the cervix. A longer vagina and excellent pelvic support can be achieved with maximum preservation of the vagina and pelvic supporting structures. A modified McCall culdoplasty and reinforcement of the cardinal ligaments are done, and the vaginal cuff is closed with everted mattress sutures either vertically or transversely. Less granulation tissue is formed on the vaginal vault and postoperative leukorrhea or postcoital vaginal bleeding is reduced. Moschcowitz culdoplasty or high McCall culdoplasty can be done at the same time to correct or prevent an enterocele or prolapsed vagina.
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PMID:Total Laparoscopic Intrafascial Hysterectomy 907 61

The differential diagnoses for anterior wall vaginal prolapse (AWVP) include cystocele, enterocele, urethral diverticulum, and Gartner duct cyst. We present a case of a patient with a known solitary right kidney (congenital absence of a left kidney) presenting with lower urinary tract symptoms, absence of urinary incontinence, and feeling of bulge in the vagina. Physical examination revealed grade II AWVP. Because congenital solitary kidney can be associated with other possible genitourinary abnormalities, a pelvic magnetic resonance imaging was obtained. Magnetic resonance imaging demonstrated a tubular structure spanning the left retroperitoneum to the region of the AWVP. Urodynamics revealed an obstructive voiding pattern during pressure-flow phase. The combination of transvaginal and transabdominal surgical excision of the tubular structure resolved the patient's lower urinary tract and prolapse symptoms. Anatomically, her AWVP was corrected. Histopathologic examination of the tubular structure revealed presence of urothelium lining the lumen of the tubular structure consistent with a ureter. This case represents the rare situation in which an ectopic ureter presented as an AWVP. However, patients with congenital solitary kidney presenting with vaginal prolapse should raise the suspicion for other associated genitourinary anomalies, whether these anomalies are related to the prolapse or not. Cross-sectional imaging should be performed in these situations to delineate precise anatomy.
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PMID:Ectopic ureter presenting as anterior wall vaginal prolapse. 2497 91