Hutch paraureteral diverticulum complicating radical hysterectomy.

BACKGROUND

Paraureteral diverticula are abnormalities of the urinary bladder which are more common in males, and thus are infrequently encountered in the patient population of the gynecologic oncologist.

CASE REPORT: A 59 year old white female, with a history of recurrent bladder cancer treated by transurethral resection, presented with an abnormal cervical cone biopsy revealing invasive squamous cell carcinoma of the uterine cervix". The patient had a known Hutch paraureteral diverticulum for which she was receiving prophylactic cyprofloxacin. Computed tomography revealed an 8.5 x 8 x 7 cm paraureteral diverticulum on the right. There was no hydronephrosis of either renal pelvis. Laparotomy revealed a mass, resembling a second urinary bladder, which was very closely associated with the bladder and lateral proximal vagina on the right. Since a urological consultant advised that the diverticulum should not be resected, dissection around the bladder and vagina for the radical hysterectomy was made much more difficult.

CONCLUSION

The presence of a paraureteral diverticulum increases the difficulty of performing a radical hysterectomy.