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Ureter adhesion to the fibroid
  1. Brahmana Askandar Tjokroprawiro
  1. Obstetrics and Gynecology, Universitas Airlangga Fakultas Kedokteran, Surabaya, Indonesia
  1. Correspondence to Dr Brahmana Askandar Tjokroprawiro; brahmanaaskandar{at}

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The prevalence of uterine fibroids ranges from 40% to 60% among women under 35 years and from 70% to 80% among women over 50 years.1 The ureter is a retroperitoneal structure in the pelvis that may be injured during surgery for fibroids. The incidence of ureteric injury in patients with fibroids that underwent hysterectomy was 0.64%.2 A large fibroid may compress the ureter and cause hydronephrosis. A retroperitoneal fibroid is a rare case, and the diagnosis is made intraoperatively.3 Thus, we should be more careful with the ureter when performing retroperitoneal fibroid surgery, as the ureter may be attached to the fibroid.

We report a case of ureter adhesion to a retroperitoneal fibroid. A woman around 40 years of age with fibroid underwent hysterectomy. Intraoperatively, a large fibroid was seen on the left side of the uterus (figure 1). The fibroid grew in the left pelvic retroperitoneal space. After opening the retroperitoneal space, we identified the ureter attached to the fibroid. The ureter was dissected and hysterectomy was successfully performed. The pathological result revealed a fibroid.

Figure 1

The ureter attached to the retroperitoneal fibroid.

Learning points

  • In large fibroids, particularly retroperitoneal fibroids, the anatomy of the ureter may be distorted.

  • Opening the retroperitoneal space and identifying or isolating the ureter is an important step during surgery for fibroids to prevent injury to the ureter.

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation result, drawing original diagrams and algorithms, and critical revision for important intellectual content: BAT. The following authors gave final approval of the manuscript: BAT.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.