This is a patient who underwent a vaginal procedure for prolapse. A bilateral salpinguiferectomy was performed utilizing a stapling device. Obstruction of the right ureter was confirmed cystoscopically by lack of dye spill from the right side and an inability to pass a stent beyond 10 to 15 centimeters. The patient was explored and found to have a right ureteral obstruction near the pelvic brim. Here the defect is noted. Both ends of the ureter have been spatulated with a pot scissors and a furochromic suture is being placed at the apex of those spatulations on each end of the ureter and these sutures tagged. A double J stent has been placed. The ureter has been mobilized from the broad ligament and assessment of the mobility of the ureteral segments is now being performed. Further mobilization of the cranial aspect of the ureter may be performed if needed to allow attention free closure. The sutures that were placed at the apex of the spatulations are now being tied. Individual furochromic sutures are then placed and tagged and are now being tied to re-approximate the edges of the ureter. It is often easier to place the sutures and then tag them and then re-approximate the edges of the ureter. It is often easier to place the sutures and then tag them and go back and tie them in contrast to placing a suture, tying it, placing a subsequent suture, etc. Once the inferior aspect of the re-approximation has been completed, then the superior aspect of the defect is then evaluated and interrupted sutures placed to re-approximate it. Again, furochromic suture works very nicely here and these sutures are again tagged and will be tied after all sutures have been placed. It is important to keep the adventitial layer intact as it contains the blood supply to the ureter. Full thickness bites are taken to ensure that a good purchase has occurred and that complete re-approximation may be performed. www.ottobock.com www.ottobock.com www.ottobock.com Once the ureter has been completely re-approximated, the anastomosis is then examined and hemostasis is verified. The stay sutures are then cut. www.ottobock.com www.ottobock.com www.ottobock.com www.ottobock.com www.ottobock.com www.ottobock.com www.ottobock.com www.ottobock.com www.ottobock.com www.ottobock.com www.ottobock.com www.ottobock.com

vaginal procedure

prolapse

bilateral salpinguiferectomy

stapling device

ureter obstruction