URETERIC obstruction; VAGINAL hysterectomy; LAPAROSCOPIC surgery; CULDOCENTESIS; KIDNEYS

Objective: To determine the frequency of ureteral obstruction like complication of the vaginal hysterectomy (VH) or laparoscopic attended vaginal hysterectomy (LAVH) with McCall's culdoplasty. To determine the feasibility, security and effectiveness of the indigo carmine test observed by routine intraoperative cistoscopy to identify the ureteral indemnity. Method: Prospective study of 56 patients submissive VH or LAVH with McCall's culdoplasty between January 2003 and May 2006, in the Unit of Gynecology of the Department of Gynecology and Obstetrics of Clinica Las Condes. The median age was 48 years old (rank: 38 to 74), BMI 25 (rank: 21 to 34), parity 2 (rank: 0 to 3). Positive test of ureteral indemnity was defined as the exit of blue coloration by both ureteral meatus. Results: Only 1 (1.8%) of the 56 patients registered a ureteral obstruction (right ureter). The McCall sutures were replaced being stated the second indigo carmine test positive verifying ureteral indemnity. Conclusions: The indigo carmine test observed by cistoscopy is a feasible, safe and effective method to determine the ureteral indemnity. In all those gynecological surgeries with a high risk of ureteral obstruction, the intraoperative cistoscopy with negative indigo carmine test allows a fast and easy solution during the same operating time, avoiding a possible kidney loss. [ABSTRACT FROM AUTHOR]

Objetivos: Determinar Ia frecuencia de obstrucción ureteral como complicación de Ia histerectomla vaginal (HV) o laparoscópica asistida vaginal (HLAV) con culdoplastia de McCall. Evaluar Ia factibilidad, seguridad y eficacia de Ia prueba con indigo carmin y de Ia cistoscopia intraoperatoria de rutina, para determinar Ia indemnidad ureteral. Método: Estudio prospectivo de 56 pacientes sometidas a HV o HLAV con culdoplastla de McCall, entre enero de 2003 y mayo de 2006, en Ia Unidad de Ginecologia del Departamento de GinecologIa y Obstetricia de Clinica Las Condes. La media de edad fue 48 años (rango: 38 a 74), IMC 25 (rango: 21 a 34), paridad 2 (rango: 0 a 3 partos). Se consideró prueba positiva de indemnidad ureteral a Ia salida del colorante a vejiga por ambos meatos. Resultados: Solo 1 (1,8%) de las 56 pacientes registró una obstrucción ureteral (ureter derecho). Se reposicionaron los puntos constatán-dose a segunda prueba con indigo carmin positiva, verificando indemnidad ureteral. Conclusion: La prueba de indigo carmin con visualización cistoscópica intraoperatoria, es.un método factible, seguro y eficaz, para determinar Ia indemnidad ureteral. En todas aquellas cirugias ginecolOgicas con alto riesgo de obstrucción ureteral, Ia cistoscopia intraoperatoria con prueba de indigo carrnmn negativa, permite realizar una solución rapida y fácil durante el mismo tiempo operatorio, evitando una posible pérdida renal. [ABSTRACT FROM AUTHOR]

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