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Souli A, Alves A, Tillou X, Menahem B. Iatrogenic ureteral injury: What should the digestive surgeon know? J Visc Surg 2024; 161:6-14. [PMID: 38242812 DOI: 10.1016/j.jviscsurg.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
PURPOSE OF THE STUDY Iatrogenic ureteral injury (IUI) is a rare but formidable complication of any abdominal or pelvic surgery. The aim of this study was to describe the epidemiology of IUI in colorectal surgery in the Basse-Normandie region over the period 2004-2022, as well as to review the literature on the management of this complication. MATERIALS AND METHODS This multicenter retrospective analysis of clinical data (medical records and operative reports) concerned 22 patients (13 men and 9 women) who suffered an IUI during colorectal surgery between 2004 and 2022. Ureteral resections for oncological purposes and endoluminal instrumental injuries (post-ureteroscopy) were excluded from the study. We also carried out a review of the literature concerning the incidence of IUI in colorectal surgery. RESULTS The incidence of IUI was 0.27% over the study period (22 ureteral injuries out of 8129 colorectal procedures). Colorectal cancer and sigmoid diverticulitis were the dominant surgical indications (85% of cases). Proctectomy and left colectomy were the most performed resection procedures (75% of cases). Surgery was scheduled in 68% of cases. The approach was open laparotomy in 59% and laparoscopy in 41% of cases. The IUI involved the left ureter in 63% of cases and the pelvic ureter in 77% of cases. Conservative endoscopic treatment by insertion of a double-J catheter stent had a success rate of 87.5%. Surgical repairs consisting of re-implantation techniques and uretero-ureteral anastomosis had a success rate of 75%. The nephrectomy rate was 13.6% (3/22) and the mortality rate 9% (2/22). A literature review identified sixteen studies, where the incidence of IUI varied from 0.1 to 4.5%. FINDINGS IUI occurring during colorectal surgery is a rare occurrence but remain a formidable complication. No means of prevention has proven its effectiveness to date, but guidance devices using illuminated ureteral catheters or dyes seem to constitute a promising approach. Injuries to the left pelvic ureter are the most common, and the majority can be treated endoscopically if diagnosed early.
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Affiliation(s)
- Abdelaziz Souli
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - Arnaud Alves
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; UNICAEN, Inserm, ANTICIPE, Normandie university, 14000 Caen, France
| | - Xavier Tillou
- Department of urology, university hospital of Caen, Caen, France
| | - Benjamin Menahem
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; UNICAEN, Inserm, ANTICIPE, Normandie university, 14000 Caen, France.
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Serafetinidis E, Campos-Juanatey F, Hallscheidt P, Mahmud H, Mayer E, Schouten N, Sharma DM, Waterloos M, Zimmermann K, Kitrey ND. Summary Paper of the Updated 2023 European Association of Urology Guidelines on Urological Trauma. Eur Urol Focus 2023:S2405-4569(23)00196-7. [PMID: 37968186 DOI: 10.1016/j.euf.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/10/2023] [Accepted: 08/31/2023] [Indexed: 11/17/2023]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Panel for Urological Trauma has produced guidelines in order to assist medical professionals in the management of urological trauma in adults for the past 20 yr. It must be emphasised that clinical guidelines present the best evidence available to the experts, but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients regarding other parameters such as experience and available facilities. Guidelines are not mandates and do not purport to be a legal standard of care. OBJECTIVE To present a summary of the 2023 version of the EAU guidelines on the management of urological trauma. EVIDENCE ACQUISITION A systematic literature search was conducted from 1966 to 2022, and articles with the highest certainty evidence were selected. It is important to note that due to its nature, genitourinary trauma literature still relies heavily on expert opinion and retrospective series. EVIDENCE SYNTHESIS Databases searched included Medline, EMBASE, and the Cochrane Libraries, covering a time frame between May 1, 2021 and April 29, 2022. A total of 1236 unique records were identified, retrieved, and screened for relevance. CONCLUSIONS The guidelines provide an evidence-based approach for the management of urological trauma. PATIENT SUMMARY Trauma is a serious public health problem with significant social and economic costs. Urological trauma is common; traffic accidents, falls, intrapersonal violence, and iatrogenic injuries are the main causes. Developments in technology, continuous training of medical professionals, and improved care of polytrauma patients reduce morbidity and maximise the opportunity for quick recovery.
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Affiliation(s)
| | | | | | - Husny Mahmud
- Department of Urology, Sheba Medical Centre, Tel-Hashomer, Israel
| | - Erik Mayer
- Department of Surgery & Cancer, Imperial College London, London, UK; Department of Urology, The Royal Marsden Hospital, London, UK
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Marjan Waterloos
- Division of Urology, Gent University Hospital, Gent, Belgium; Division of Urology, AZ Maria Middelares, Gent, Belgium
| | - Kristin Zimmermann
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Noam D Kitrey
- Department of Urology, Sheba Medical Centre, Tel-Hashomer, Israel.
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Wendler JJ, Meyer F, March C, Cash H, Porsch M, Schostak M. [Traumatic injuries of the kidney and the urinary tract in blunt abdominal trauma]. CHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00104-023-01906-w. [PMID: 37428182 DOI: 10.1007/s00104-023-01906-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND In the context of blunt abdominal trauma, injuries to the urinary tracts often occur, especially in polytrauma patients. Urotrauma is rarely immediately life-threatening but can lead to serious complications and chronic functional limitations during treatment. Therefore early urological involvement is crucial for adequate interdisciplinary treatment. METHODS The most important facts for the clinical routine on the consultant urological management of urogenital injuries in blunt abdominal trauma are discussed according to the European "EAU guidelines on Urological Trauma" and the German "S3 guidelines on Polytrauma/Treatment of Severely Injured Patients" as well as the relevant literature. RESULTS Urinary tract injuries can occur even with an initially inconspicuous status and always require explicit exclusion diagnostics by means of contrast medium tomography of the entire urinary tract and, if necessary, by means of urographic and endoscopic examinations. The most common urological intervention is catheterization of the urinary tract which is often required. Less common is urological surgery, which should be coordinated interdisciplinarily with visceral and trauma surgery. More than 90% of vitally threatening kidney injuries (usually up to the American Association for the Surgery of Trauma (AAST) grades 4-5) are now treated by interventional radiology. CONCLUSION Due to possible complex injury patterns in blunt abdominal trauma, these patients should ideally be directed to (certified) trauma centers with subspecialized or maximum care from the departments of visceral and vascular surgery, trauma surgery, interventional radiology and urology.
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Affiliation(s)
- Johann J Wendler
- Klinik für Urologie, Uroonkologie, robotergestützte und fokale Therapie, Universitätsklinikum Magdeburg A.ö.R., Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg., Deutschland.
| | - F Meyer
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A.ö.R., Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - C March
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - H Cash
- Klinik für Urologie, Uroonkologie, robotergestützte und fokale Therapie, Universitätsklinikum Magdeburg A.ö.R., Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg., Deutschland
| | - M Porsch
- Klinik für Urologie, Uroonkologie, robotergestützte und fokale Therapie, Universitätsklinikum Magdeburg A.ö.R., Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg., Deutschland
| | - M Schostak
- Klinik für Urologie, Uroonkologie, robotergestützte und fokale Therapie, Universitätsklinikum Magdeburg A.ö.R., Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg., Deutschland
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Haruishi M, Matsuoka A, Tate S, Arai T, Ichikawa T, Usui H. Delayed postrenal failure due to progression of asymptomatic hydronephrosis following hysterectomy. J Obstet Gynaecol Res 2023. [PMID: 36792054 DOI: 10.1111/jog.15614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
Asymptomatic hydronephrosis following hysterectomy is generally transient. Here, we present the case of a 52-year-old woman who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for benign indications. Computed tomography (CT) to examine bleeding on the second postoperative day incidentally revealed bilateral grade II hydronephrosis. Asymptomatic hydronephrosis was not reevaluated, and gynecological outpatient follow-up was terminated with a normal creatinine level on postoperative day 43. On postoperative day 107, the patient noticed weight gain of 10 kg, decreased urine output, and generalized edema. The serum creatinine level was elevated to 5.4 mg/dL, and CT revealed bilateral grade III hydronephrosis. Urgent bilateral ureteral stenting was performed to treat stenosis of the distal ureters that caused postrenal failure. Ureteroneocystostomy was performed for strict stenosis of the right ureter at 10 months postoperatively. Histological examination of the resected distal ureter showed inflammation and fibrosis. Asymptomatic hydronephrosis developing after hysterectomy progress to delayed postrenal failure.
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Affiliation(s)
- Mana Haruishi
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ayumu Matsuoka
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shinichi Tate
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Arai
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hirokazu Usui
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
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Zhang P, Xie W, Zhang Y. The "Hand as Foot" teaching method in anatomy of the crossover of ureter and reproductive vessels. Asian J Surg 2023:S1015-9584(22)01795-X. [PMID: 36653297 DOI: 10.1016/j.asjsur.2022.12.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/22/2022] [Indexed: 01/17/2023] Open
Affiliation(s)
- Peijin Zhang
- Department of Gynecology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Wanying Xie
- Department of Gynecology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Yu Zhang
- Department of Gynecology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China.
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Ouattara A, Pare AK, Kabore FA, Yameogo C, Ky D, Bayané D, Ye D, Kambou T. Iatrogenic Ureteral Injuries Associated with Gynecological and Surgical Procedures: Our Experience About 18 Cases and Literature Review. Res Rep Urol 2021; 13:289-293. [PMID: 34079774 PMCID: PMC8164722 DOI: 10.2147/rru.s299590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022] Open
Abstract
Aim To describe the epidemiological aspects, etiology and outcome of iatrogenic ureteral injury repair at the urology division of Souro Teaching Hospital of Bobo Dioulasso (Burkina-Faso). Patients and Methods This was a retrospective descriptive study of consecutive patients with iatrogenic ureteric injuries who were referred and managed in the urology division of Souro Sanou Teaching Hospital (Bobo-Dioulasso) from January 2012 to December 2017. Variables studied were age, the time at the diagnosis, the causative event, the method of repair, and the outcome of the management. Results The mean age was 37.72±3.5 years coming from the rural population in most cases. The mean time at the diagnosis was 15 days. The injuries were due to gynecologic surgeries with hysterectomy (66%) and caesarian section (33%). Ureteric reimplantation with anti-reflux system was performed in seventeen patients. The rate of treatment success was 94% and the postoperative course was uneventful for all the patients. Conclusion Iatrogenic ureteric lesions at the department of urology of Sanou Sourou teaching hospital of Bobo Dioulasso were mainly caused by gynecologic and obstetric surgeries like hysterectomy and caesarian section.
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Affiliation(s)
- Adama Ouattara
- Division of Urology, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - Abdoul-Karim Pare
- Division of Urology, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | | | - Clotaire Yameogo
- Division of Urology, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Desire Ky
- Division of Urology, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Dramane Bayané
- Division of Urology, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - Delphine Ye
- Division of Urology, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - Timothee Kambou
- Division of Urology, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso
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