Delayed Imaging To Visualize Ureteral Jets

Journal of Gynecologic SurgeryVol. 37, No. 3 Pictures and ImagesFree AccessDelayed Imaging to Visualize Ureteral JetsShana Miles and Noah RindosShana MilesAddress correspondence to: Shana Miles, MD, PhD, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women's Hospital of UPMC, 300 Halket Street, Pittsburgh, PA 15213, USA E-mail Address: milessm3@upmc.eduDepartment of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania, USA.Uniformed Services University, Bethesda, Maryland, USA.Search for more papers by this author and Noah RindosDepartment of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania, USA.Search for more papers by this authorPublished Online:31 May 2021https://doi.org/10.1089/gyn.2021.0034AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail A 23-year-old woman with chronic pelvic pain underwent laparoscopic excision of endometriosis tissues. Intraoperatively, endometriosis was noted on the right uterosacral ligament near the right ovarian fossa and within the left ovarian fossa. Pathology testing confirmed endometriosis. She presented ∼2 weeks postoperatively with abdominal pain and bloating. Delayed imaging computed tomography (CT) of her abdomen and pelvis was completed to evaluate her for ureteral and bowel injuries (Fig. 1). Ureteral jets were visualized (Figs. 2 and 3), and no injuries were noted throughout her genitourinary system.FIG. 1. Patency of ureter near collecting system. White arrows point to ureters.FIG. 2. Computed tomography with delayed imaging showing ureteral jet approaching bladder. White arrow points to ureteral jet.FIG. 3. Computed tomography with delayed imaging showing ureteral jet entering bladder. White arrow points to ureteral jet.A meta-analysis of women undergoing gynecologic surgery for benign indications found an adjusted ureteric-injury rate of 0.3% with 0.7–1.6 postoperative ureteric injury detection rates per 1000 surgeries.1 These injuries might be partial or complete and require a high index of suspicion. While magnetic resonance imaging (MRI) can enable evaluation of the urinary tract without radiation exposure, MRI is limited by its cost and availability, compared to computed tomography (CT). Use of CT with delayed images can detect iatrogenic ureteral injuries that might be overlooked with conventional CT.2 Delayed imaging is typically completed in multiple phases and acquires images at least 3–5 minutes after injection of intravenous contrast dye to evaluate the excretory phase. As the dye travels through the ureters, its course can be tracked from the kidneys to the bladder. A ureteral or bladder injury will lead to extravasation of dye into the pelvis, while ligation of ureter will present with hydronephrosis and incomplete passage of dye to the level of the bladder. Delayed imaging with CT should be considered when utilizing imaging to detect injury to the lower genitourinary system in the postoperative setting.This submission was exempt from institutional review board approval. Consent was obtained from the patient prior to submission of this article.AcknowledgmentsThe views expressed in this article are those of the authors and do not reflect the official policy or position of the U.S. Air Force, Department of Defense, or the U. S. Government.Author Disclosure StatementNo financial conflicts of interest exist.References1. Teeluckdharry B, Gilmour D, Flowerdew G. Urinary tract injury at benign gynecologic surgery and the role of cystoscopy: A systematic review and meta-analysis, Obstet Gynecol 2015;126:1161. Google Scholar2. Alabousi A, Patlas MN, Menias CO, et al. Multi-modality imaging of the leaking ureter: Why does detection of traumatic and iatrogenic ureteral injuries remain a challenge? Emerg Radiol 2017;24:417. Crossref, Medline, Google ScholarFiguresReferencesRelatedDetails Volume 37Issue 3Jun 2021 InformationCopyright 2021, Mary Ann Liebert, Inc., publishersTo cite this article:Shana Miles and Noah Rindos.Delayed Imaging to Visualize Ureteral Jets.Journal of Gynecologic Surgery.Jun 2021.261-262.http://doi.org/10.1089/gyn.2021.0034Published in Volume: 37 Issue 3: May 31, 2021Online Ahead of Print:April 12, 2021Keywordsureteral patencyureteral injurylaparoscopic surgeryPDF download