Novel Role of Dehydrated Human Amnion/Chorion Membrane in Healing of Denuded Ureter in Robot-Assisted Excision of Endometriosis

Abstract

Ureteral injury is an uncommon but potentially morbid complication following any open or endoscopic pelvic procedure. Gynecologic surgeries alone make up 50 percent of nonurologic ureteral injuries leading to prolonged hospital stays, secondary interventions, and potential loss of renal function. The use of AmnioFix ® a processed dehydrated, immunologically privileged cellular amniotic membrane allograft has been well established in urologic and gynecologic procedures. These allografts contain human extracellular matrix components, growth factors, and cytokines that mediate inflammation and facilitate would healing. We report the first application of AmnioFix on a denuded ureter during a case of robotic-assisted excision of endometriosis. We include a literature review and discussion on the management outcomes of iatrogenic injury to the ureters.

Figure 1

Intraoperative finding of left ureteral injury with subserosal hematoma (yellow arrow).

Figure 2

AmnioFix membrane wrapped around the site of left ureteral injury. AmnioFix membrane identified by yellow arrow.

Figure 3

Left ureter following AmnioFix membrane placement. AmnioFix membrane identified by yellow arrow.

Figure 4

Left retrograde pyelogram shows 1.5 cm distal ureteral stricture with mild hydroureteronephrosis.

Figure 5

Mild extravasation noted on the left ureter with continued contrast injection.

Figure 6

Renal scan: initial findings show mild asymmetrical activity in the left ureter compared to the right. However, washout at 20 min is symmetrical bilaterally without any signs of obstruction.

Figure 7

Renogram findings identical for left (red) and right (green) kidney: symmetrical downward slope consistent with no signs of obstruction bilaterally.