A 40-Year-Old Woman with No Spill from Her Left Ureter on Postoperative Cystoscopy after Total Laparoscopic Hysterectomy with Bilateral Salpingectomy

A 40-year-old female, gravida 1, para 1, presents for follow-up with history of heavy menses and uterine leiomyomas. She tried hormonal treatment to control her bleeding but was not successful. For the past two years she bleeds monthly for seven days, and changes pads every 2 hours. She requested definitive treatment and underwent a total laparoscopic hysterectomy (TLH), and bilateral salpingectomy. Intraoperatively, the cul-de-sac was observed to be partially obliterated due to the presence of dense adhesions, which limited the visualization of the left ureter. Multiple intramural and subserosal fibroids were visualized. At the end of the procedure a cystoscopy was performed, the bladder mucosa was intact without lesions. Right ureteral jet was visualized with clear urine, no spill or peristalsis was visualized from the left side. Her past medical history is significant for pelvic inflammatory disease. Her past surgical history is non-contributory. She is not taking medications and has no known allergies.