Early Presentation of Iatrogenic Ureteric Thermal Injury Causing Ureterovaginal Fistula after Laparoscopic Hysterectomy: A Case Report

Introduction: Diagnosing ureteral injuries during pelvic laparoscopic surgeries is challenging and requires high suspicion, surgical proficiency, and understanding of ureteric anatomy. These injuries can cause serious consequences. The present study presents a case of iatrogenic ureterovaginal fistula that developed shortly after a laparoscopic hysterectomy conducted for the purpose of gender reassignment surgery.Case presentation: A 23-year-old female with gender dysphoria underwent laparoscopic hysterectomy and oophorectomy for gender reassignment. After a clear discharge from the vagina, a CT scan revealed damage to the left ureter and contrast leakage. Double-J stent implantation was planned, but unsuccessful due to left ureter obstruction. A double dye test confirmed a urinary tract fistula. A ureteroscopy session was performed, but Double-J stent implantation was unsuccessful. The patient underwent ureteroneocystostomy using the Modified Lich-Gregoir technique. After 6 weeks, the Double-J stent was discharged without any specific complaints or abnormalities.Conclusion: The case study emphasizes the importance of early detection and diagnosis of uretrovaginal fistulas, using spiral CT scans and retrograde cystography. Despite initial complications, the Modified Lich-Gregoir technique successfully addressed thermal injury and ureteral interruption, leading to a smooth recovery and a multidisciplinary approach.