2025 Volume 21 Issue 1 Pages 68-72
When we perform laparoscopic and robot-assisted sacrocolpopexy, we routinely perform intraoperative cystoscopy to check for ureteral injury.
Among 204 sacrocolpopexy procedures, we report two instances in which intraoperative cystoscopy was instrumental in diagnosing ureteral obstruction caused by fixation sutures. One case involved a 71-year-old woman with stage III uterine prolapse and cystocele who underwent robot-assisted sacrocolpopexy. The second case was of a 61-year-old woman with the same condition, treated by laparoscopic sacrocolpopexy.
In both cases, it was suspected that the sutures had inadvertently involved the bladder serosa or muscularis propria, leading to kinking of the intramural ureter. After mesh placement on the anterior vaginal wall, routine cystoscopy revealed ureteral obstruction. Consequently, the sutures near the bladder were removed, after which urine efflux from the ureteral orifice was confirmed.
Although the retroperitoneal ureter is visible during laparoscopy, the intramural portion of the ureter cannot be directly visualized. In laparoscopic and robot-assisted sacrocolpopexy (LSC/RSC), where multiple stitches are placed on the vaginal wall in close proximity to the bladder, careful attention must be paid to needle placement. A routine intraoperative cystoscopy is valuable for enhancing surgical safety by detecting ureteral obstruction, which may occur despite appropriate precautions.
