[A Case Report of a Pregnant Woman who Had Urethral Avulsion during Vacuum Extraction Delivery and Ipsilateral Kidney].

Abstract

The incidence of lower urinary tract injuries associated with vaginal delivery is 0.03-0.05%, and reports of urethral injuries related to vacuum delivery are also extremely uncommon. We report a case of urethral injury in a 29-year-old woman during her first pregnancy and delivery due to vacuum extraction. The urethral injury occurred in continuity with a vaginal laceration on the opposite side of the midline episiotomy. A cystoscopy performed after urethral repair did not reveal the left ureteral orifice. Further examination revealed that the left kidney was not identifiable on ultrasound, and no accumulation was observed on DMSA renal scan. Cystoscopy revealed an irregular image of the left anterior vaginal wall, suggesting the presence of a Gartner's duct cyst, while vaginal contrast imaging showed a ureter-like luminal structure emerging from the left vaginal wall. These findings raised the possibility that the ureter from the left kidney opened into the Gartner's duct cyst, rendering it non-functional and that the weakness of the vaginal wall due to the Gartner cyst contributed to the urethral injury.