HealthDay News — For patients with a pre-existing unknown nonfunctional kidney, cystoscopy to confirm ureteral patency after hysterectomy may lead to an incorrect assumption of a ureteral injury, according to a case report published in the September issue of Obstetrics & Gynecology.
Kuhali Kundu, DO, from Einstein Medical Center in Philadelphia, and colleagues describe two cases in which cystoscopy was performed in patients with a pre-existing unknown nonfunctional kidney to confirm ureteral patency after hysterectomy.
Two cases are presented by the researchers: a 42-year-old woman who underwent an attempted vaginal hysterectomy converted to abdominal hysterectomy and a 35-year-old woman who underwent vaginal hysterectomy. Neither patient underwent preoperative evaluation of the kidneys. Cystoscopy to confirm ureteral patency with intravenous indigo carmine was performed in both cases; there was no efflux of blue-tinted urine from the right ureteral orifice and the patients underwent further exploratory surgery. While the second patient was under anesthesia, discussion with the family revealed that the patient had been diagnosed with a unilateral nonfunctional kidney of unknown etiology as a child. Both patients underwent extensive additional operating room time (three and 3.5 hours, respectively) in addition to radiation exposure.
“Cystoscopy to confirm ureteral patency after hysterectomy may lead to an incorrect presumption of a ureteral injury in patients with a pre-existing nonfunctional kidney,” the authors write.