Two cases of preoperative identified duplicated renal pelvis and ureter for safety total laparoscopic hysterectomy

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  • 重複腎盂尿管を術前に診断し全腹腔鏡下子宮全摘術を安全に施行できた2例
  • チョウフクジンウニョウカン オ ジュツゼン ニ シンダン シ ゼン フククウキョウ カ シキュウ ゼンテキジュツ オ アンゼン ニ シコウ デキタ 2レイ

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Abstract

<p>Laparoscopic total hysterectomy (TLH) has a predominantly higher frequency of ureteral injury than with abdominal surgery. In the present study, we experienced two cases in which drip infusion pyelography (DIP) was performed and ureteral stenting was performed preoperatively in patients with bilateral duplicate pyelonephric ureters and ureteral injury was avoided. Case 1 was a case 49-year-old female. She was referred to our clinic for uterine fibroids, excessive menstruation, and enlarged myomas, and the plan was to operate. She had a pregnancy history of one pregnancy and one birth (one cesarean section). Preoperative DIP showed two left ureters, which were fused at the level of the iliac bone and the following were fused at the level of the iliac bone, so we suspected an incomplete duplicate left pyelic ureter. A ureteral stent was placed and surgery was performed. We confirmed one left and one right ureter on cystoscopy and incomplete duplicate left pyelic ureter. Case 2 is a 45-year-old woman. After five courses of GnRH analogue, she was referred to our hospital for surgical treatment of uterine fibroids. She had a history of three pregnancies and three deliveries (three cesarean sections). The patient underwent a preoperative DIP examination, and a bilateral pyelogram and ureteral stent were placed, as in case 1. Both cases were confirmed no bladder damage and the outflow of indigo carmine administered intravenously through all ureteral orifice after the stent was removed. Preoperative DIP can confirm the presence or absence of a urinary tract malformation, and implantation of a ureteral stent can reduce intraoperative complications. Preoperative DIP can confirm the presence of urinary tract malformations and implantation of a ureteral stent was considered important to prevent intraoperative ureteral injury. [Adv Obstet Gynecol, 74 (3) : 343-350, 2022 (R4.8)]</p>

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