Recurrent Paravaginal Abscess: An Unusual Presentation of a Distal Ectopic Ureteral Remnant

Abstract

Introduction: Obstructed hemivagina ipsilateral renal agenesis (OHVIRA) is a rare syndrome with limited data on both treatment and postoperative sequelae, specifically of ectopic ureters to the vagina. Case Description: This case study describes a 22-year-old patient with OHVIRA syndrome presenting with pelvic pain and drainage from a chronic vaginal abscess secondary to a remnant distal ectopic ureter after nephrectomy and proximal ureterectomy. Imaging was significant for a right paravaginal abscess. Previously, the patient was treated with conservative therapy and on presentation her evaluation confirmed a right paravaginal abscess. She subsequently underwent a robot-assisted incision and drainage of the paravaginal abscess and excision of the remnant distal ectopic ureter. She did well postoperatively without recurrence. Discussion: We discuss the successful surgical technique used to identify and excise a paravaginal abscess. We also highlight the unique anatomy of a patient with OHVIRA syndrome. Lastly, we underline the importance of a complete resection of an ectopic ureter to the vagina at the time of nephrectomy, given the potential risk of ascending chronic infection and recurrent abscess formation.