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Chatroux LR, Einarsson JI. Keep your attention closer to the ureters: Ureterolysis in deep endometriosis surgery. Best Pract Res Clin Obstet Gynaecol 2024; 95:102494. [PMID: 38614884 DOI: 10.1016/j.bpobgyn.2024.102494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 04/15/2024]
Abstract
Endometriosis surgery involving the ureter poses significant challenges requiring meticulous surgical techniques and vigilant postoperative care. This chapter addresses key aspects of ureterolysis techniques, intraoperative management of ureteral injuries, and postoperative care in the context of endometriosis surgery. Ureterolysis methods aim to isolate and mobilize the ureter while preserving its vascularity. Cold instruments and careful dissection are recommended to prevent thermal injury during surgery. Intraoperative tools such as indocyanine green (ICG) show promise in assessing for vascular compromise. Over half of ureteral injuries are detected postoperatively, necessitating a high index of suspicion. Optimal postoperative care in the case of ureteral injury involves Foley catheterization for decompression, ureteral stenting, and meticulous follow-ups to monitor healing and renal function. While advances have been made in surgical techniques and diagnostic tools, gaps persist in preoperative imaging optimization and predictive models for identifying at-risk patients. This chapter aims to bridge existing knowledge gaps, optimize surgical practices, and enhance the overall care and outcomes of patients undergoing endometriosis surgery involving the ureter.
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Affiliation(s)
- Louisa R Chatroux
- Brigham & Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology Division of Minimally Invasive Gynecologic Surgery, Harvard Medical School, Boston, MA, USA.
| | - Jon I Einarsson
- Brigham & Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology Division of Minimally Invasive Gynecologic Surgery, Harvard Medical School, Boston, MA, USA
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Dong X, Zhao S, Liu P, Yu Q, Yan L. Congenital interruption between the ampulla and fimbria of the fallopian tube: case report. AJOG GLOBAL REPORTS 2024; 4:100353. [PMID: 38818346 PMCID: PMC11137536 DOI: 10.1016/j.xagr.2024.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
We reported 5 patients with unilateral or bilateral tubal discontinuity between the ampulla and fimbria, occasionally detected through laparoscopy combined with hysteroscopy at the Reproductive Hospital Affiliated with Shandong University from 2017 to 2023. Three cases were observed to have this malformation on the left fallopian tube, 1 case on the right side, and 1 case bilaterally. None of these cases were combined with urological malformations. After surgery, there was 1 instance of postoperative delivery, 1 ongoing pregnancy, and 3 not yet conceived. The congenital ampulla and fimbria interruption of the fallopian tube may be independent of other significant deformities of reproductive or renal tracts. However, it can lead to hydrosalpinx and primary or secondary infertility. Surgical management options, such as salpingostomy, salpingectomy, and tubal ligation, have shown the potential to improve pregnancy outcomes.
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Affiliation(s)
- Xiaotong Dong
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China (Drs Dong and Liu)
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, China (Drs Dong, Zhao, Liu, Yu, and Yan)
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China (Drs Dong, Zhao, Liu, Yu, and Yan)
| | - Shengrui Zhao
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, China (Drs Dong, Zhao, Liu, Yu, and Yan)
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China (Drs Dong, Zhao, Liu, Yu, and Yan)
| | - Peng Liu
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China (Drs Dong and Liu)
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, China (Drs Dong, Zhao, Liu, Yu, and Yan)
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China (Drs Dong, Zhao, Liu, Yu, and Yan)
| | - Qian Yu
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, China (Drs Dong, Zhao, Liu, Yu, and Yan)
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China (Drs Dong, Zhao, Liu, Yu, and Yan)
| | - Lei Yan
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, China (Drs Dong, Zhao, Liu, Yu, and Yan)
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China (Drs Dong, Zhao, Liu, Yu, and Yan)
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Zhang LL, Wang L, Zhang DN, Wu JT, Liu Y, Wang YP. Case report: Ureteric bud intestinal-type adenocarcinoma involving the cervix was misdiagnosed as a large cervical fibroid. Front Med (Lausanne) 2024; 11:1374653. [PMID: 38681049 PMCID: PMC11045929 DOI: 10.3389/fmed.2024.1374653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/22/2024] [Indexed: 05/01/2024] Open
Abstract
Background Malignant tumors of the ureteric bud are not common, and cervical involvement is even rarer. So far, there have been no such cases in the literature. Case summary A 50-year-old woman developed intermittent light bleeding in the past 7 months and lower abdominal pain in the past 2 months. The human papillomavirus 16 (HPV) DNA, P16 chemical staining, thinPrep cytology test (TCT), and cervical and cervical canal tissue biopsy were all negative. Pelvic color Doppler ultrasound exhibited incomplete mediastinal uterus and heterogeneous echo from the cervical canal to the posterior wall of the cervix. Pelvic contrast-enhanced CT showed left cervical mass, left retroperitoneal mass, absence of the left kidney, and mediastinal uterus. An increase in human epididymal protein 4 (HE4) (133.6 pmol/L) was detected, while other tumor markers were at normal levels. Based on these examination results, a diagnosis of "cervical fibroids, left retroperitoneal mass, incomplete mediastinal uterus, left kidney deficiency"[SIC] was conducted, and expanded hysterectomy, right adnexectomy, and left retroperitoneal mass resection were performed. Through intraoperative rapid pathological diagnosis, postoperative pathological diagnosis combined with the re-evaluation of laboratory, and imaging and intraoperative examination results, the patient was diagnosed with ureteric bud intestinal-type adenocarcinoma involving the cervix. The patient has been tracked and followed up for approximately 11 months. She underwent six courses of chemotherapy. At present, the medication has been discontinued for 4 months, and there is no recurrence, metastasis, or deterioration of the tumor. Conclusion For large masses of the cervix, it is feasible for the operation to be performed, improving the prognosis. There were a few limitations. A preoperative aspiration biopsy of masses was not performed to differentiate benign from malignant. Preoperative urography was not performed to clarify the function of the malformed urinary system structure. Partial cystectomy should be performed simultaneously with the resection of the ureteric bud for intestinal-type adenocarcinoma. In this case, a partial cystectomy was not performed, which can only be compensated with postoperative chemotherapy. Moreover, this patient did not undergo genetic screening, and it is currently unclear whether there are any genetic mutations associated with ureteric bud intestinal adenocarcinoma.
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Affiliation(s)
- Li-li Zhang
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Li Wang
- Department of Obstetrics and Gynecology, The 964th Hospital, Changchun, Jilin, China
| | - Dan-ni Zhang
- Department of Obstetrics and Gynecology, The 964th Hospital, Changchun, Jilin, China
| | - Jun-tong Wu
- Department of Obstetrics and Gynecology, The 964th Hospital, Changchun, Jilin, China
| | - Yuan Liu
- Department of Obstetrics and Gynecology, The 964th Hospital, Changchun, Jilin, China
| | - Yan-ping Wang
- Obstetrics and Gynecology Diagnosis and Treatment Center, The Affiliated Hospital, Changchun University of Chinese Medicine, Changchun, Jilin, China
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Bairaktaris D, Chorianopoulou E, Kokkali K, Stanc G, Iavazzo C. Endometrial Cancer in a Patient With Didelphys Uterus and a History of Renal Cancer: A Case Report and Literature Review. Cureus 2023; 15:e47114. [PMID: 38021547 PMCID: PMC10647939 DOI: 10.7759/cureus.47114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Müllerian duct anomalies (MDAs) concurrent with endometrial cancer are exceptionally rare, with only a few documented cases. Here, we present a case of endometrial cancer in both horns of a didelphys uterus in a 54-year-old woman with a history of renal cancer, who underwent left radical nephrectomy and left salpingo-oophorectomy. The patient sought medical evaluation due to postmenopausal vaginal bleeding. Hysteroscopy with dilation and curettage revealed the presence of two cervixes and two endometrial cavities, with pathology results indicating endometrioid adenocarcinoma (G1). Preoperative MRI staging confirmed the diagnosis of a double cervix and uterus. Subsequently, an open abdominal hysterectomy and a right salpingo-oophorectomy were performed, revealing a didelphys uterus (International Federation of Gynaecology and Obstetrics 2018, stage IA). This manuscript aims to explore the potential correlation between renal and endometrial malignancies in the presence of MDAs.
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Affiliation(s)
| | | | | | - Gabriela Stanc
- Pathology, Metaxa Memorial Cancer Hospital, Piraeus, GRC
| | - Christos Iavazzo
- Gynecological Oncology, Metaxa Memorial Cancer Hospital, Piraeus, GRC
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Skoczek AC, Sylvester J. Cervically Embedded Fragment of an Intrauterine Device in a Patient with a Bicornuate Uterus: A Case Report and Review of Current Management Strategies. Cureus 2023; 15:e40938. [PMID: 37496525 PMCID: PMC10368404 DOI: 10.7759/cureus.40938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/25/2023] [Indexed: 07/28/2023] Open
Abstract
Intrauterine devices (IUDs) have become one of the most frequently used forms of long-acting reversible contraception (LARC) in women of childbearing age. While complications are generally considered to be minimal, they can occur during the insertion, during use, or upon removal. Uterine anomalies, such as a bicornuate uterus, can increase the risk of complications during all stages. Here, we describe a case of a patient with a bicornuate uterus who had a levonorgestrel IUD in place for five years before she experienced a dislodging of the IUD, fragmentation upon attempted removal, and ultimately required a hysteroscopy to remove an embedded fragment from the endocervical canal. Due to the limited reporting on fragmented IUDs, further studies will be required to assess the optimal management. While symptomatic patients should have the fragment removed, asymptomatic patients should have their individual history and desire for future pregnancy weighed against the risk and benefits of treatment.
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Affiliation(s)
- Alexandra C Skoczek
- Medicine, Edward Via College of Osteopathic Medicine - Auburn, Huntsville, USA
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Caputo A, Califano A, Addesso M, Caleo A, Zeppa P, D’Antonio A. Non-urothelial lesions of the urinary bladder A 14.5-year, single-institution review. Pathol Res Pract 2022; 237:153998. [DOI: 10.1016/j.prp.2022.153998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
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Rubin ES, Huttler A, Mainigi M, Roe AH. Cervix Surgical uterine evacuation in patients with two cervices: a case series. Contraception 2022; 108:73-77. [PMID: 35031305 DOI: 10.1016/j.contraception.2022.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/29/2021] [Accepted: 01/02/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe the clinical circumstances, surgical approach, intraoperative challenges, and outcomes of patients with two cervices undergoing uterine evacuation for spontaneous, incomplete, or induced abortion at our institution. STUDY DESIGN We used diagnostic and procedure codes related to uterine anomalies and uterine evacuation to identify patients with cervical duplication who underwent uterine evacuation at Penn Medicine from January 2008 to December 2020. RESULTS We identified fifteen patients with cervical duplication in whom we performed uterine evacuations during nineteen pregnancies. We describe in detail each patient's first pregnancy with uterine evacuation at our institution, of which providers performed eleven in the first trimester and four in the second trimester. Ten patients had a known diagnosis of cervical duplication prior to pregnancy. Five patients did not have a diagnosis of cervical duplication prior to pregnancy and providers newly made this diagnosis intraoperatively either at our institution or referring clinics. Providers at outside institutions referred three patients to our institution for incomplete procedures. At our institution, one patient had a procedure notable for a major complication. Eight other cases were notable for surgical challenges including difficulty placing osmotic dilators, difficulty identifying the correct cervix for local anesthesia, and contralateral cervical and uterine horn instrumentation. CONCLUSIONS This case series suggests surgical abortion in patients with two cervices is rare, but generally safe. The majority of patients did not have major complications, despite presenting a variety of unique procedural challenges. Surgical providers were sometimes the first to make the diagnosis of a second cervix.
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Affiliation(s)
- Elizabeth S Rubin
- Perelman School of Medicine at the University of Pennsylvania, Department of Obstetrics and Gynecology, Philadelphia, PA 19104, United States.
| | - Alexandra Huttler
- Perelman School of Medicine at the University of Pennsylvania, Department of Obstetrics and Gynecology, Philadelphia, PA 19104, United States
| | - Monica Mainigi
- Perelman School of Medicine at the University of Pennsylvania, Department of Obstetrics and Gynecology, Philadelphia, PA 19104, United States
| | - Andrea H Roe
- Perelman School of Medicine at the University of Pennsylvania, Department of Obstetrics and Gynecology, Philadelphia, PA 19104, United States
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Oppelt P, Binder H, Birraux J, Brucker S, Dingeldein I, Draths R, Eckoldt F, Füllers U, Hiort O, Hoffmann D, Hoopmann M, Hucke J, Korell M, Kühnert M, Ludwikowski B, Mentzel HJ, Mon OʼDey D, Rall K, Riccabona M, Rimbach S, Schäffeler N, Shavit S, Stein R, Utsch B, Wenzl R, Wieacker P, Zeino M. Diagnosis and Therapy of Female Genital Malformations (Part 2). Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/052, May 2019). Geburtshilfe Frauenheilkd 2021; 81:1329-1347. [PMID: 34899046 DOI: 10.1055/a-1471-4988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 10/19/2022] Open
Abstract
Objectives Female genital malformations may be present in the form of individual entities, they may involve neighboring organs or they may occur in the context of complex syndromes. Given the anatomical structures of the vulva, vagina, uterus and uterine appendages, the clinical picture of malformations varies greatly. Methods This S2k-guideline was developed by representative members from different medical specialties and professions as part of the guidelines program of the DGGG, SGGG and OEGGG. The recommendations and statements were developed and voted on using a structured consensus process with neutral moderation. Recommendations This guideline is the first comprehensive summary of female genital malformations from infancy to adulthood which covers clinical examinations, diagnostic workups and treatment options. Additional chapters have been included on complex urogenital malformations, vascular malformations, psychosomatic care, and tumor risk.
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Affiliation(s)
- Peter Oppelt
- Universitätsklinik für Gynäkologie, Geburtshilfe & gynäkologische Endokrinologie, Kepler Universitätsklinikum Linz, Linz, Austria
| | - Helge Binder
- Universitätsklinik für Gynäkologie, Geburtshilfe & gynäkologische Endokrinologie, Kepler Universitätsklinikum Linz, Linz, Austria
| | - Jacques Birraux
- Klinik für Kinderchirurgie, Universitätsklinikum Genf, Genf, Switzerland
| | | | - Irene Dingeldein
- Universitätsklinik für Frauenheilkunde, Insel Spital, Bern, Switzerland
| | | | - Felicitas Eckoldt
- Klinik für Kinderchirurgie, Universitätsklinikum Jena, Jena, Germany
| | | | - Olaf Hiort
- Hormonzentrum für Kinder und Jugendliche - Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Dorit Hoffmann
- Klinik für Kinder- und Jugendmedizin, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Jürgen Hucke
- Klinik für Frauenheilkunde und Geburtshilfe, Agaplesion Bethesda Krankenhaus, Wuppertal, Germany
| | - Matthias Korell
- Klinik für Gynäkologie und Geburtshilfe, Johanna Etienne Krankenhaus, Neuss, Germany
| | - Maritta Kühnert
- Klinik für Geburtshilfe und Perinatalmedizin, Universitätsklinikum Marburg, Marburg, Germany
| | - Barbara Ludwikowski
- Klinik für Kinderchirurgie und -urologie, Kinder- und Jugendkrankenhaus auf der Bult, Hannover, Germany
| | - Hans-Joachim Mentzel
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Jena, Germany
| | - Dan Mon OʼDey
- Klinik für Plastische, Rekonstruktive und Ästhestische Chirurgie und Handchirurgie, Luisenspital Aachen, Aachen, Germany
| | | | - Michael Riccabona
- Klinische Abteilung für Kinderradiologie, Universitätsklinikum Graz, Graz, Austria
| | - Stefan Rimbach
- Abteilung für Gynäkologie und Geburtshilfe, Krankenhaus Agatharied, Hausham, Germany
| | - Norbert Schäffeler
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Sandra Shavit
- Klinik für Kinderchirurgie, Luzerner Kantonsspital, Luzern, Switzerland
| | - Raimund Stein
- Zentrum für Kinder-, Jugend- und Rekonstruktive Urologie, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Boris Utsch
- Abteilung für Allgemeine Pädiatrie und Neonatologie, Universitätsklinikum Gießen/Marburg, Gießen, Germany
| | - Rene Wenzl
- Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Austria
| | - Peter Wieacker
- Institut für Humangenetik, Universitätsklinikum Münster, Münster, Germany
| | - Mazen Zeino
- Universitätsklinik für Kinderchirurgie, Insel Spital, Bern, Switzerland
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