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A Delayed Type of Ureteric Injury Developed After Transobturator Mesh Procedure for Massive Prolapse

Dass, Anil Krishna MMed (O&G)*†; Lo, Tsia-Shu MD*; Khanuengkitkong, Siwatchaya MD*‡; Tan, Yiap Loong MD, MRCOG

Female Pelvic Medicine & Reconstructive Surgery: May/June 2013 - Volume 19 - Issue 3 - p 179–180
doi: 10.1097/SPV.0b013e31827de9f8
Case Reports

We report on a rare case of delayed presentation of ureteric injury with a transobturator mesh kit for anterior vaginal wall prolapse repair along with conventional vaginal pelvic reconstructive surgery: a case of a 56-year-old multiparous, postmenopausal woman with a body mass index of 22.1 kg/m2, who had continuous leakage of urine per vagina 28 days after vaginal hysterectomy, mesh-augmented anterior repair with Avaulta Plus Anterior support system kit (CR Bard Inc, Covington, Ga), and sacrospinous ligament fixation for stage IV pelvic organ prolapse. Pelvic computed tomographic scan with contrast revealed an intact bladder, right hydroureteronephrosis, and right ureterovaginal fistula. Immediate laparotomy performed revealed that the right lower mesh arm was entangled with the distal end of the right ureter, 1.5 cm from the ureteric orifice. Category, time, site classification was 4CaT2S5. Right ureteric reimplantation was performed uneventfully. We herein emphasize that the development of a delayed type of ureteric injury is a possible associated complication of transobturator mesh surgery for the prolapse.

Case report of a woman with right lower ureteric injury caused by the right lower mesh arm of the Avaulta Plus anterior support system.

From the *Division of Urogynaecology, Department of Obstetrics & Gynaecology, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China; †Urogynaecology Unit, Department of Obstetrics & Gynaecology, Penang Hospital, Penang, Malaysia; ‡Department of Obstetrics & Gynaecology, Faculty of Medicine, Prince Songkla University, Hatyai, Songkla, Thailand; and §Department of Obstetrics & Gynaecology, Sarawak General Hospital, Kuching, Sarawak, Malaysia.

Reprints: Tsia-Shu Lo, MD, Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin St, Kwei-shan, Tao-Yuan Hsien, Taiwan 333, Republic of China. E-mail:

The authors have declared they have no conflicts of interest

© 2013 by Lippincott Williams & Wilkins