LAPAROSCOPIC URETERAL REIMPLANTATION FOR URETERAL LESION SECONDARY TO TRANSVAGINAL ULTRASONOGRAPHY FOR OOCYTE RETRIEVAL OSCAR EDUARDO FUGITA AND LOUIS KAVOUSSI ABSTRACT Transvaginal ultrasound-guided follicular puncture for oocyte retrieval is a highly efficient and minimally invasive method for assisted reproductive techniques. Complications related to this procedure are rare. We report the case of a ureteral stricture secondary to ultrasound-guided follicular puncture for oocyte retrieval that was corrected by a laparoscopic approach. This approach can minimize postoperative pain, the length of hospitalization, and the period of convalescence and should be considered a minimally invasive option in the management of this rare complication of oocyte retrieval. UROLOGY 58: 281i–281iii, 2001. © 2001, Elsevier Science Inc. I atrogenic injury to the ureter is a risk of any pelvic surgery. The advent of minimally invasive procedures has increased the incidence of this complication. 1,2 Transvaginal ultrasound-guided follicular puncture for oocyte retrieval is a highly efficient and minimally invasive method for as- sisted reproductive techniques. 3 Complications re- lated to this procedure are rare. 4 We report the case of a ureteral stricture secondary to ultrasound- guided follicular puncture for oocyte retrieval that was corrected by a laparoscopic approach. CASE REPORT A 41-year-old woman presented with a 2-week history of dysuria, frequency, fevers, chills, and left-sided flank pain. The onset of the symptoms was concomitant to the last in vitro fertilization therapy with oocyte retrieval using transvaginal ul- trasound scanning for follicular puncture. She had had left pyelonephritis more than 1 year previously and had never passed urinary stones or had hema- turia. Her gynecologic history included laparo- scopic myomectomy 5 years before presentation and five oocyte retrieval procedures during the previous 2 years. A renal ultrasound scan demonstrated severe left ureterohydronephrosis. A percutaneous ne- phrostomy tube was placed, and antegrade and retrograde pyelographies confirmed moderate ureterohydronephrosis with a distal left ureteral obstruction (Fig. 1). Computed tomography re- vealed no pelvic masses, urinary lithiasis, or surgi- cal clips; however, the distal left ureteral obstruc- tion at a level between the vagina and the left ovary was confirmed. An uneventful left laparoscopic ureteral reim- plantation was performed with three trocars. An area of dense tissue scar involving the distal ureter was present. The operation lasted 210 minutes and the estimated blood loss was 200 mL. The patient was discharged on postoperative day 2 and after 6 months of follow-up had no postoperative compli- cations and no obstruction to urinary flow on renal ultrasound scanning, intravenous pyelography, or diuretic renography (Fig. 2). COMMENT Iatrogenic injury to the ureter is commonly re- lated to an obstetric or a gynecologic procedure. 5 With the advent of minimally invasive approaches, such as laparoscopy and ureteroscopy, the inci- dence of this complication has increased. 1,2,6 Oocyte recovery by means of transvaginal ultra- sound-guided puncture was first described in 1985, 7 and, because of its great efficiency and low From the James Buchanan Brady Urological Institute, Johns Hop- kins Medical Institutions, Baltimore, Maryland Address for correspondence: Oscar Eduardo Fugita, M.D., De- partment of Urology, Johns Hopkins Hospital, Jefferson Street Building, 600 North Wolfe Street, Suite 161, Baltimore, MD 21287-8915 Submitted: January 30, 2001, accepted (with revisions): March 20, 2001 CASE REPORT © 2001, ELSEVIER SCIENCE INC. 0090-4295/01/$20.00 ALL RIGHTS RESERVED PII S0090-4295(01)01147-5 281i