Case notes

A 51 year old woman (gravida 3, para 2) presented to the urogynecology clinic for evaluation of symptomatic pelvic organ prolapse. She had no urinary or defecatory symptoms. Her surgical history was notable for an uncomplicated laparoscopic supracervical hysterectomy performed 18 months previously for symptomatic uterine fibroids. On examination, her anterior vaginal wall and cervix prolapsed 3 cm beyond the hymen, and her posterior fornix and posterior vaginal wall were well supported. She consented to undergo trachelectomy with sacrospinous ligament suspension and anterior colporrhaphy.

Intravenous indigo carmine was administered at the completion of an uncomplicated pelvic floor reconstruction, and routine cystoscopy was performed. Bilateral ureteral efflux was noted. The bladder mucosa appeared normal with the exception of a raised mass involving the left ureteral orifice ( Figure and Video ).

The left ureteral orifice was noted to be raised and dilated during routine cystoscopy. Note the efflux of indigo carmine-stained urine from the orifice and the visibility of the blue color through the thin wall of an apparent mass. Recorded footage from this cystoscopy demonstrating ureteral efflux from the ureterocele can be viewed in the Supplementary Content .

Berger. An incidental finding. Am J Obstet Gynecol 2010 .

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