OVARIAN REMNANT CAUSING LOWER URETERIC OBSTRUCTION

            A 35 Y lady presented with left flank pain since - 3 months. She had h/o hysterectomy with rt oophorectomy 6 y ago and ? left ovarian cystectomy/ oophorectomy 6m ago. Physical examination was normal. On evaluation there was left hydroureteronephrosis on USG. CTIVU revealed left lower ureteric obstruction. Diuretic Renogram revealed partial obstruction in the drainage of left kidney, with decreased relative function. She was planned for Left RGP and proceed. On RGP - there was splaying of lower ureter, which did not fillup initially of left lower ureter. Diagnostic ureteroscopy was normal. DJ stent kept.  Further plan is to get FSH, CA 125 and sos medical menagement and USG guided aspiration. If this fails she will need surgical exploration and excision of cyst/release of ureter from adhesions.

USG showing left hydronephrosis

CTIVU showing obstruction of midureter due to cystic lesion

CTIVU showing obstruction of midureter due to cystic lesion

CTIVU showing obstruction of midureter due to cystic lesion

CTIVU showing obstruction of midureter due to cystic lesion

Diuretic renogram confirming obstruction and impaired renal function

Diuretic renogram confirming obstruction and impaired renal function

Left RGP showing HDUN due to splaying of ureter in the pelvis

SOME INFORMATION ON REM