Plasenta akreata cerrahisinde tesadüfen saptanan idiopatik megaüreter

Abstract

Üreter varyasyonları sıkça görülmekte olup, en sık çeşidi çift üreterdir. Nadir bir çeşit olan genişlemiş ureter ‘megaüreter’ olarak tanımlanmaktadır. Primer veya bir anormalliğe bağlı olarak sekonder olabilir. Primer megaüreterin ana nedeni fonksiyonel olmakla birlikte sekonder tipi ise anatomic bir darlık nedenli veya mesaneden idrar akışına doğuştan gelen subvezikal engel nedeniyle olmaktadır. Bu vakamızda, 35 yaşında plasenta akreata spektrumlu ve 5. sezaryenini olacak bir kadını sunduk. Sezaryen histerektomi yapıldı ve cerrahi sırasında retroperitoneal alan kontrolünde sağ üreterin ciddi şekilde dilate olduğu gözlendi. Üreter dilatasyonu araştırıldı ve idiopatik olduğu tespit edildi. Sonuç olarak, major jinekolojik cerrahilerde üreterler mutlaka kontrol edilmeli ve dilate üreterin her zaman iatrojenik bir komplikasyon olmadığı unutulmamalıdır.

Keywords

• Üreter
• plasenta akkreta
• sezaryen histerektomi

Idiopathic megaureter incidentally detected during placenta accreta surgery

Abstract

As ureter variations can be seen common and the most common type of is duplication. Rare type of a variation is widening of ureter which is defined as ‘megaureter’. It can be primary or secondary to an abnormality. The main cause for primary megaureter is functional while for the secondary is due to an anatomical narrowing or an inborn subvesical obstacle to urine flow from bladder. In this case, we presented 35 years old woman diagnosed with placenta accreta spectrum and fifth cesarean section. We performed cesarean hysterectomy and during the surgery, it was observed that the right ureter was severely dilated during the retroperitoneal control of surgery area. Dilatation of ureter was evaluated, and it was diagnosed as idiopathic. In conclusion, despite ureters should be checked during major gynecological surgeries, detection of a dilated ureter during surgery does not always mean an iatrogenic complication.

Keywords

• Ureter
• plasenta accreta
• cesarean hysterectomy

References

1. 1. Report of working party to establish an international nomenclature for the large ureter. Birth Defects Orig. Artic. Ser. 13.
2. 2. Selzman AA, S.J. Iatrogenic ureteral injuries: a 20-year experience in treating 165 injuries. J Urol 1996; 155:878-881.
3. 3. CK, P. Ureteral injuries in the female: fistulas and obstruction. In: Raz S (ed). Female Urology. 2nd ed. Philadelphia: W.B. Saunders, 1996: 507-520.
4. 4. Gilmour DT, D.P. Carey MP. Lower urinary tract injury during gynecologic surgery and its detection by intraoperative cystoscopy. Obstet Gynecol 1999; 94: 883- 889.
5. 5. Hemal AK, A.M. Doddamani D, Gupta NP. Symptomatic and complicated adult and adolescent primary obstructive megaureterdindications for surgery: analysis, outcome, and follow-up. Urology 2003 April;61:703e7.
6. 6. Tatlisen A, E.O. Direct nipple ureteroneocystostomy in adults with primary obstructed megaureter. J Urol 2005 March;173:877e80.