Early Presentation of Iatrogenic Ureteric Thermal Injury Causing Ureterovaginal Fistula after Laparoscopic Hysterectomy: A Case Report

Abstract

Introduction Diagnosing ureteral injuries during pelvic laparoscopic surgeries is challenging and requires high suspicion, surgical proficiency, and understanding of ureteric anatomy. These injuries can cause serious consequences. The present study presents a case of iatrogenic ureterovaginal fistula that developed shortly after a laparoscopic hysterectomy conducted for the purpose of gender reassignment surgery. Case presentation A 23-year-old female with gender dysphoria underwent laparoscopic hysterectomy and oophorectomy for gender reassignment. After a clear discharge from the vagina, a CT scan revealed damage to the left ureter and contrast leakage. Double-J stent implantation was planned, but unsuccessful due to left ureter obstruction. A double dye test confirmed a urinary tract fistula. A ureteroscopy session was performed, but Double-J stent implantation was unsuccessful. The patient underwent ureteroneocystostomy using the Modified Lich-Gregoir technique. After 6 weeks, the Double-J stent was discharged without any specific complaints or abnormalities. Conclusions The case study emphasizes the importance of early detection and diagnosis of uretrovaginal fistulas, using spiral CT scans and retrograde cystography. Despite initial complications, the Modified Lich-Gregoir technique successfully addressed thermal injury and ureteral interruption, leading to a smooth recovery and a multidisciplinary approach. © 2025 Urology Research Center (URC), Tehran University of Medical Sciences.