Presence of a uterine horn and fallopian tube within an indirect hernial sac: report of a rare case

An inguinal hernia containing an ovary, fallopian tube, and uterus is an extremely rare occurrence in a woman of reproductive age. We herein report a case of a uterine horn from a bicornuate uterus, left ovarian ligament, and partially left fallopian tube within the left inguinal sac and canal diagnosed through laparoscopy in a 23-year-old female who is infertile.     

A Case of Unique Communication Between Blind-Ending Ectopic Ureter and Ipsilateral Hemi-Hematocolpometra in Uterus Didelphys

Uterus didelphys with double vagina and hemi-vaginal atresia is a rare syndrome of congenital anomalies. A 17-year-old girl had a right blind-ending ectopic ureter, the proximal end of which communicated with the ipsilateral uterine cervix of uterus didelphys. The patient presented with vaginal urinary incontinence after incision of the vaginal wall for right hemi-hematocolpometra. Following various examinations, the ipsilateral kidney was found to be absent. The ectopic ureter and communicating duct were resected, and the fistula was closed. The genesis of malformation of the female genitalia and urinary tract resulting in such a unique communication is discussed. The importance of preoperative meticulous examinations, including cysto-genitography, pelvic magnetic resonance imaging and panendoscopy with the patient under anesthesia, is emphasized.     

Ureteral endometriosis: a case report and a review of the Japanese literature

A 42-year-old woman was referred to our hospital because of abdominal fullness and a large abdominal mass. Computed tomography (CT) demonstrated bilateral ovarian tumors, uterine myoma and left hydronephrosis. On excretory urography the left kidney was not visualized and retrograde pyelography (RP) revealed left hydronephrosis and a filling defect in the left lower ureter. Based on the diagnoses of endometriosis of bilateral ovaries, uterine myoma and a left ureteral tumor, abdominal total hysterectomy, right salpingo-oophorectomy and partial ureterectomy were performed. Pathologically, in the uterus, both leiomyoma and adenomyosis, and endometriosis of the right ovary and ureter were diagnosed. Medication with buserelin acetate was started.     

Laparoscopic management of a transitional cell carcinoma arising in a right ectopic ureter

Ectopic ureter is a rare abnormality, so presenting a transitional cell carcinoma (TCC) arising from an ectopic ureter is extremely rare. We report here a case of a man with an invasive transitional cell carcinoma arising from a right ectopic ureter and managed by laparoscopy. To our knowledge, this is the fourth case described in the literature, and the second case of a TCC arising in a right ectopic ureter.     

Ectopic ureter accompanied by giant ureteral stone and pyonephrosis

We report a rare case of ectopic ureter accompanied by a giant ureteral stone and pyonephrosis. A 19-year-old Japanese woman consulted our hospital due to low-grade fever and pain in the left flank. The patient had seeping urinary incontinence since childhood. Ultrasonography demonstrated left dysplastic lumbar kidney with hydronephrosis and plain kidney-ureter-bladder film showed a left giant ureteral stone. The left kidney showed no excretion of contrast medium on drip infusion pyelography. After further examination, a diagnosis of left simple ectopic ureter emptying into the vagina was made. Percutaneous nephrostomy penetrating the major psoas muscle was carried out for intractable pyonephrosis, followed by left nephroureterectomy and lithectomy. These procedures resulted in improvement in the patient's symptoms.     

Hernia uterus inguinale associated with unicornuate uterus

Hernia uterus inguinale, a condition in which endometrium and myometrium are found in an ectopic location in the inguinal canal, is a rare congenital abnormality in women. A woman with a normal number of chromosomes (46,XX) demonstrated the presence of a uterus, fallopian tube, and ovary in an inguinal hernia associated with a unicornuate uterus. This represents a unique abnormality in the spectrum of lateral fusion defects associated with müllerian ductal development, which normally proceeds as the right and left systems fuse and form the uterus, cervix, and four fifths of the vagina. In this patient, the left müllerian system apparently failed to fuse with the right, instead assuming a location within the patient's inguinal canal.     

Anatomy of the uterus

The uterus is a pear-shaped organ made up of a fundus, body, isthmus and cervix. The fallopian tube enters at each superolateral angle, above which lies the fundus. The cervix is gripped by the vagina to form a supra-vaginal and a vaginal part. The uterine canal traverses the internal os and emerges as the external os at the vaginal vault. The uterine body is flexed on the cervix (anteflexion) while the whole uterus is tipped forward (anteversion). Variations of these positions, termed retroflexion and retroversion, may occur in normal anatomy as well as under pathological circumstances. The ureter has an important relationship to the uterus, lying above the lateral fornix, about 12 mm from the supravaginal cervix. Here it is crossed superiorly by the uterine vessels and is at risk of injury in pelvic surgery, especially hysterectomy. In the child, the cervix is twice the size of the uterine body, but at puberty the body enlarges to its adult proportions. The cervical os is circular, but becomes a transverse slit in the parous woman. The cervix is normally firm, but feels soft in pregnancy. The details of the arterial supply, venous drainage, lymphatic drainage, peritoneal coverings and anatomical relationships are described.     

Anatomy of the uterus

The uterus is a pear-shaped organ made up of a fundus, body, isthmus and cervix. The fallopian tube enters at each superolateral angle, above which lies the fundus. The cervix is gripped by the vagina to form a supra-vaginal and a vaginal part. The uterine canal traverses the internal os and emerges as the external os at the vaginal vault. The uterine body is flexed on the cervix (anteflexion) while the whole uterus is tipped forward (anteversion). Variations of these positions, termed retroflexion and retroversion, may occur in normal anatomy as well as under pathological circumstances. The ureter has an important relationship to the uterus, lying above the lateral fornix, about 12 mm from the supravaginal cervix. Here it is crossed superiorly by the uterine artery and is at risk of injury in pelvic surgery, especially hysterectomy. In the child, the cervix is twice the size of the uterine body, but at puberty the body enlarges to its adult proportions. The cervical os is circular, but becomes a transverse slit in the parous woman. The cervix is normally firm, but feels soft in pregnancy. The details of the arterial supply, venous drainage, lymphatic drainage, peritoneal coverings and anatomical relationships are described.     

A case of adenocarcinoma of the urinary bladder arising 45 years after ileal replacement of ureter for tuberculous ureteral stricture

We report a case of adenocarcinoma arising in the urinary bladder 45 years after ileal replacement of ureter for tuberculous ureteral stricture. A 65-year-old man was admitted with gross hematuria. Cystoscopic examination demonstrated a broadbased non-papillary tumor on the left posterior wall of the bladder and a papillary tumor at the anastomotic site between the bladder and ileal segment. Total cystectomy and construction of ileal conduit were performed. The histopathological examination demonstrated well differentiated adenocarcinoma of the bladder and ileal ureter. Intestinal metaplasia widely infiltrated into the bladder epithelium around the anastomotic site.     

Extensive cellulitis as the first symptom of ureter lesion after laparoscopic hysterectomy

Laparoscopic hysterectomy as an alternative to abdominal hysterectomy is frequently performed for benign uterine pathology. Although laparoscopic hysterectomy is associated with less pain, quicker recovery, and better short-term quality of life, it is associated with an increased risk of ureter lesions compared with the open procedure. We point out the case of a woman who underwent a total laparoscopic hysterectomy and presented postoperatively with a cellulitis at the right side of the body expanding over the abdomen and the pelvis, and subsequently problems with micturition. Computed tomography demonstrated a lesion of the left ureter nearby the ureterovesical junction. Cellulitis was treated with clindamycin, and a nephrostomy catheter was placed since the placement of a Double-J stent was not possible. Six weeks after surgery, a ureter re-anastomosis was performed by laparotomy. Urine leakage into the abdomen combined with urinary tract infection or infection of the wounds can lead to rapid extension of cellulitis and is therefore an important additional symptom for urological complications after a laparoscopic hysterectomy.     

Ureteral obstruction associated with pelvic inflammatory disease in a long-term intrauterine contraceptive device user

We report herein a case of ureteral obstruction associated with pelvic inflammatory disease in a long-term intrauterine contraceptive device (IUD) user. A 62-year-old woman presented with a 2-week history of left flank pain and high fever, but no abdominal pain. She had forgotten the use of an IUD. Retrograde pyelography showed a stricture in the lower third of the left ureter. Magnetic resonance showed swelling of the uterus wall and left parametria, but did not reveal the presence of an IUD. Subtotal hysterectomy, bilateral salpingo-oophorectomy and left nephronureterectomy was performed. The IUD was then found in the uterine cavity. The results of pathological and bacteriological findings for Actinomyces infection were negative. Therefore we diagnosed this case as ureteral obstruction associated with pelvic inflammatory disease. Ureteral obstruction associated with pelvic inflammatory disease in a long-term IUD user is extremely rare.     

Hydronephrosis due to ureteral endometriosis treated by transperitoneal laparoscopic ureterolysis

Ureteral obstruction secondary to endometriosis is relatively uncommon. We present a 43-year-old multiparous woman who suffered from periodic left loin pain in the terminal period of her menstruation. Excretory urogram demonstrated left hydronephrosis and hydroureter and obstruction of the lower left ureter just inferior to the left sacroiliac joint without urolithiasis. An enhanced computed tomography scan showed soft tissue density mass around the left ureter at the level of the stenosis. She underwent transperitoneal laparoscopic ureterolysis and adhesiotomy of the left ureter under the diagnosis of ureteral endometriosis. Because blueberry spots were clearly observed on the pelvic brim, the fibrous tissue surrounded the ureter was removed with peritoneal bleeding spots. Histological examination of the surrounding tissue confirmed the ectopic endometriosis. Even though retroperitoneoscopy is frequently used for ureteral lesion, transperitoneal laparoscopy has an advantage for resection of ectopic endometriosis surrounding the ureter.     

Ectopic ureter as cause of pyonephrosis and urinary incontinence

Ectopic ureter accounts with an incidence of 1 in 2000 newborns. When present, ectopic ureter can be associated with duplex kidneys in an 85 % of the cases. Clinical manifestations of this malformation include incontinence and urinary tract infections. Ectopic ureter frequently occurs in association with a dysplastic upper pole renal moiety. When a poorly functioning upper pole segment is present, a standard surgical treatment is upper pole heminephrectomy. A 23-years old woman presented with left renal colic pain, fever and urinary leak. Ultrasound, intravenous pyelogram and antegrade pyelogram revealed a partial duplex right kidney and a complete duplex left kidney with hydronephrosis and ectopic insertion into the urethra of the left upper pole moiety. Following diagnosis upper pole heminephrectomy and partial ureterectomy was performed.     

Pediatric radical abdominal trachelectomy for anaplastic embryonal rhabdomyosarcoma of the uterine cervix: an alternative to radical hysterectomy

Rhabdomyosarcoma arising in the female genital tract carries 5-year survival in excess of 80%, but lifelong infertility may be a consequence of local control strategies. We present the technique and outcome for a fertility-sparing, radical abdominal trachelectomy in a 12-year-old girl with anaplastic, embryonal rhabdomyosarcoma involving the uterine cervix. The patient had presented to our center after the piecemeal resection of a uterine cervical mass; because of concern about microscopic residual disease, we classified her as group II-A according to the Intergroup Rhabdomyosarcoma Study system. Staging studies excluded the presence of distant disease. The patient received 4 cycles of multiagent chemotherapy and then underwent radical abdominal trachelectomy, with removal of the uterine cervix, parametria, vaginal cuff, and regional lymph nodes. Microscopically, the specimen showed treatment effect and no residual tumor. Regional nodes were negative. Radical abdominal trachelectomy, which has not been previously reported for rhabdomyosarcoma, has appeared to secure local disease control in this case while preserving the patient's future fertility potential. In properly selected cases of rhabdomyosarcoma of the uterine cervix, where involvement of the uterus proper is not present, radical abdominal trachelectomy may be an attractive fertility-sparing alternative to radical hysterectomy.     

Adenocarcinoma of the sigmoid segment 38 years after sigmoidcystoplasty : a case report

A 60-year-old woman presented at another hospital with a complaint of voiding difficulty. She had had left nephrectomy and bladder augmentation using the sigmoid colon for treatment of urinary tract tuberculosis 38 years ago. Left ovarian tumor was found by computed tomography and she was referred to our hospital. Another tumor which involved the uterus, bladder, and urethra was revealed by magnetic resonance imaging. An anterior pelvic exenteration was performed with preoperative diagnosis of left ovarian cancer with peritoneal dissemination. Histopathological examination revealed a clear cell adenocarcinoma of the left ovary and a sigmoid cancer arising in the augmented bladder. The sigmoid cancer arose from the anastomotic site between the bladder and sigmoid segment. This is the 34th case of neoplasms following augmentation enterocystoplasty reported in Japan.     

Transitional cell carcinoma in an ectopic ureter

We experienced an 82-year-old man with transitional cell carcinoma in an ectopic ureter draining into the prostatic urethra. Carcinoma arising from an ectopic ureter is very rare and a differential diagnosis is difficult. To our knowledge, our case is the third male case reported in the literature.     

Newborn with klinefelter syndrome and posterior urethral valves

We describe the case of a 10-day-old term infant with 47,XXY, in association with posterior urethral valves, a right ectopic ureter, a right dysplastic kidney, left hydronephrosis, cryptorchidism, and encephalomalacia. The renal anomaly was diagnosed prenatally by ultrasonography, and additional evaluation was performed after birth. Urinary tract anomalies are uncommon in Klinefelter syndrome. Unilateral and bilateral renal agenesis have been described. We describe, to our knowledge, the first case of posterior urethral valves, ectopic ureter, and encephalomalacia in association with 47,XXY.     

Case report: Minimally invasive treatment of an unusual obstructive ectopic upper pole ureter

An 18-year old man presented with left loin pain and recurrent urinary tract infections. Ultrasound and IVU revealed a duplex left kidney with hydronephrosis of the upper pole moiety. F-15 Mag-3 renography confirmed obstruction of the upper pole moiety. Cysto-urethroscopy identified the site of ectopic insertion to be adjacent to the verumontanum in the prostatic fossa. Retrograde ureterography showed the level of obstruction and dilation of the stricture was carried out. Post operatively, the patient became asymptomatic and remains so at 5-year follow up. This is an unusual case of obstructive upper pole ureter with an ectopic insertion into the prostatic fossa. We also demonstrated that dilatation of a stricture at this site can achieve good long term outcome.     

Vaginal pedicled flap for closure of vesicovaginal fistula

A 22-year-old woman presented with chronic urinary tract infections and was found to have an ectopic ureter. Repair involved ligation of the distal ectopic ureter via a vaginal approach. She developed an iatrogenic vesicovaginal fistula which was repaired with a vaginal pedicled flap.     

Capillary hemangioma of the uterine cervix: an unusual cause of vaginal bleeding in a child.

Only a few scattered reports of hemangiomas of the female genital tract are found in the literature. Most of them are in adults, very few of which are located in the uterus, and none in the cervix. We present a very unusual case of profuse vaginal bleeding from a benign hemangioma in a 6-yr-old girl. Its location in the uterine cervix required complete surgical excision.