Surgical and Pre-Operative Considerations for Managing Pelvic Organ Prolapse in a Patient with a Müllerian Duct Anomaly

Excerpt

The incidence of urinary tract abnormalities in females with Müllerian anomalies is approximately 30% [1]. Ureteric injuries may occur in 5.1% of patients having vaginal surgery for pelvic organ prolapse [2]. Thus, it is critical for surgeons operating on patients with Müllerian anomalies to delineate the anatomy of the urinary tract. Useful modalities include: pre-/intra-operative imaging, ureteric stenting and intra-operative cystoscopy, which may be used to document integrity of the urinary tract and reduce rates of unrecognized urologic injury. We describe the management of procidentia in a patient with uterus didelphys, one of the least common Müllerian duct anomalies. There is limited information on this topic in the literature. In a recent report of prolapse managed surgically in a patient with previous nephrectomy, the authors highlight the importance of taking additional measures to avoid ureteric injury [3]. …