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In this video, we present a case of laparoscopic vaginoplasty using the Davydov technique. The
technique is applied with the patient in the gynecological position. First, laparoscopic exploration
exposes the Douglas pouch. Thereafter the vaginal space is created from the perineum. With the
help of a thick bougie dilator, the pelvic peritonium is dissected laparoscopically and then with-
drawn to the perineum using clamps introduced from the perineum. Once suitable vaginal depth is
acheived a thick purse string suture is used the seperate the peritoneum from the vaginal cavity.
The peritoneum - perineum anastomosis is performed from the perineal aspect.
The most important advantages of vaginoplasty using the peritoneum is no requirement for loss of
continuity of bowels and no mucous secretion.
VS-28 (VS without presentation)
LAPAROSCOPIC MANAGEMENT OF ECTOPIC URETER
WITH VAGINAL INSERTION DIAGNOSED IN ADULT FEMALE
Krzysztof RATAJCZYK
1
, Adrian CZEKAJ
2
, Marek FIUTOWSKI
2
, Pawel PIOTROW
2
and Pawel KOWAL
2
1) Regional Specialistic Hospital In Wroclaw, Department of Urology, Wroclaw, POLAND - 2) Regional Specialistic
Hospital in Wroclaw, Departament of Urology, Wroclaw, POLAND
INTRODUCTION
Ectopic ureters are rare and usually accompanied with double collecting system. Ectopic ureter with
the orifice in urethra distal to external sphincter or emptying to uterus, vagina and vestibulum may
cause incontinence in females. We present a late diagnosed case of ectopic insertion of right upper
pole ureter to the lateral vaginal wall.
MATERIAL AND METHODS
A 27-year-old female patient with normal urination presented with a continuous urine dribbling
since her childhood. Ultrasound and urodynamic study results were normal. IV urography identified
bilateral double collecting system. MR urography showed right upper pole ureter emptying to the
vagina. An embolisation attempt was made to functionally disable upper pole collecting system of
the right kidney. It was unsuccessful due to a lack of renal artery branches specific to upper pole
on the angiography. Therefore, the surgical treatment was indicated. Double - J stent was inserted
preoperatively to aid identification of lower pole ureter. The patient underwent a transperitoneal
laparoscopic ureteropielostomy. The anastomosis of the upper pole ureter to the lower pole pelvis
was made using 4-0 monofilament running suture.
RESULTS
The surgical time was 145 min and estimated blood loss 100 cc. The double - J stent was removed
on the first postoperative day after no leakage had been observed. The patient presented with no
perioperative complications and was discharged on the third postoperative day. At three months
follow-up, the patient was dry and had non-dilated right renal collecting system on ultrasound.
CONCLUSIONS
Detection of ectopic ureter with vaginal insertion in adulthood is extremely rare. Magnetic resonance
urography is the most appropriate imaging tool for determining renal collecting system anatomy and
localising ectopic ureteral orifice. Laparoscopic ureteropielostomy is a safe and feasible treatment
option of ectopic ureter and double collecting system for a female patient in reproductive age.