Delayed diagnosis of ureterovaginal fistula with severe hydronephrosis after abdominal hysterectomy

A case report

Abstract

Introduction: Ureteral injury is an uncommon but serious complication of total abdominal hysterectomy. Delayed diagnosis may lead to progressive hydronephrosis, deterioration of renal function, and the need for complex reconstructive surgery. Early recognition is essential to prevent long-term morbidity. Objective: To describe a case of delayed diagnosis of ureterovaginal fistula following total abdominal hysterectomy and its clinical implications. Methods: We report the case of a 50-year-old woman who underwent total abdominal hysterectomy for abnormal uterine bleeding secondary to uterine fibroids. The immediate postoperative course was initially unremarkable; however, she developed persistent vaginal urinary leakage that was not promptly investigated. Three months after surgery, a contrast-enhanced computed tomography urogram revealed severe unilateral hydronephrosis associated with a distal ureterovaginal fistula. Renal function tests showed normal creatinine levels. Results: The patient subsequently underwent ureteral reimplantation with ureteroneocystostomy, with satisfactory postoperative recovery. Following surgical correction, vaginal leakage resolved, and imaging demonstrated improvement of hydronephrosis. Renal function remained stable at follow-up. Conclusion: Persistent urinary leakage after hysterectomy should raise immediate suspicion of ureteral injury. Delayed diagnosis may result in severe hydronephrosis and increased surgical complexity. Early imaging evaluation is crucial to preserve renal function and optimize clinical outcomes.

Recibido: 14/04/2026

Aprobado: 06/05/2026