ABSTRACT
BACKGROUND: Pregnancy occurring after uterine artery embolization are often complicated by adverse fetal and obstetric outcomes. CASE: This report describes the case of a myometrial defect in a subsequent pregnancy after uterine artery embolization for postpartum hemorrhage. A 26-year-old G2, P2 woman had a vaginal delivery of twins 2 years earlier that required uterine artery embolization for postpartum hemorrhage. In this case, she presented at 183 weeks gestation with pelvic pain and an ultrasound scan revealing an area of myometrium measuring 3.2 mm. The myometrium progressively thinned to 0.7 mm at 32 weeks. After cesarean hysterectomy, pathologic examination revealed large myometrial defects separate from the placenta increta. CONCLUSION: Given the myometrial defects and placenta increta observed in a pregnancy after uterine artery embolization without documented fibroids or uterine surgery, consideration should be given to antenatal myometrial thickness surveillance.
Subject(s)
Myometrium/pathology , Placenta Accreta/diagnosis , Postpartum Hemorrhage/surgery , Uterine Artery Embolization/adverse effects , Adult , Cesarean Section , Diagnosis, Differential , Female , Humans , Hysterectomy , Magnetic Resonance Imaging , Myometrium/diagnostic imaging , Parity , Perinatal Care , Placenta Accreta/diagnostic imaging , PregnancyABSTRACT
BACKGROUND: Post-hysterectomy vesicovaginal fistula (VVF) is rare. In addition to conventional abdominal and vaginal approaches, robotic-assisted VVF repairs have recently been described. We present a case of an extravesical, robotic-assisted VVF repair, without placement of an interposition graft performed in a Canadian teaching center. CASE: A 51-year-old woman presented with urinary incontinence 5 days after laparoscopic hysterectomy. Computed tomography cystogram, cystoscopy, and methylene blue dye test, confirmed a VVF above the bladder trigone. The patient underwent a robotic-assisted VVF repair 3 months after presentation, without complication. An abdominal, extravesical approach was used. Operative time was 116 min and repeat CT cystogram showed no evidence of persistent. CONCLUSION: We have demonstrated that a VVF repair, using a robotic-assisted, extravesical approach without interposition graft placement, can be safe, less invasive and have a successful outcome at 1 year of follow-up.
Subject(s)
Laparoscopy/methods , Robotic Surgical Procedures/methods , Vesicovaginal Fistula/surgery , Female , Humans , Middle Aged , Operative Time , Treatment Outcome , Urinary Incontinence/etiology , Urinary Incontinence/surgeryABSTRACT
This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.
Subject(s)
Gynecology/standards , Obstetrics/standards , Urinary Incontinence, Stress/surgery , Canada , Female , Humans , Patient Satisfaction , Societies, Medical , Treatment OutcomeABSTRACT
This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.
