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Majhi J, Mishra BN, Majhi MM. Prevalence and Risk Associated With Bladder Injuries During Caesarean Section in a Secondary Care Hospital. Cureus 2024; 16:e59249. [PMID: 38813343 PMCID: PMC11134211 DOI: 10.7759/cureus.59249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Bladder injury during caesarean section (CS) is not uncommon. Various factors increase the risk of bladder injury during CS, including prolonged labor with bladder distension, pregnancy with a scarred uterus, suspected intra-abdominal adhesions, distorted local anatomy, cesarean hysterectomy, and an increasing number of previous CS. Vigilant preoperative assessment and surgical precision are essential to mitigate these risks and ensure optimal outcomes for mother and child. Objectives To find out the prevalence and risk factors associated with bladder injuries during caesarean section. Methodology Hospital-based retrospective record review of 3600 pregnant women who had undergone cesarean section during the period January 2015 to December 2023 were included in the study. Data was analyzed using SPSS software, version 22 (trial version) (IBM Corp., Armonk, NY). The Chi-square test and Fisher's exact test were used. Ethical clearance was obtained from the Institutional Ethics Committee at Tata Main Hospital Noamundi (approval number NI/CMO/26/24). Result Bladder injury prevalence was reported to be 1.1%. Bladder injuries were significantly (p<0.0001) more among the CS cases with underlined complications as compared to CS cases without any underlined complications. Repeat CSs were found to have a significantly (p<0.001) higher proportion of bladder injuries compared to primary CS. Conclusion Bladder injuries during cesarean section are a significant concern. The risk factors identified, such as the number of previous cesarean sections and complications during pregnancy, highlight the importance of careful preoperative assessment and surgical precision to prevent such injuries.
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Affiliation(s)
- Jaysingh Majhi
- Obstetrics and Gynaecology, Tata Steel Hospital, Joda, IND
| | | | - Madan M Majhi
- Community Medicine, Srirama Chandra Bhanja (SCB) Medical College, Cuttack, IND
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Shang MY, Tian LX, Tian CX, Chen WJ, Yu CY, Wang Z, Wang J, Lian DB, Xu GZ, Du DX, Li TX, Amin B, Zhang NW, Wang L. Giant lipoma in the Retzius space resected under laparoscopy: A case report. Exp Ther Med 2024; 27:3. [PMID: 38223329 PMCID: PMC10785029 DOI: 10.3892/etm.2023.12290] [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: 05/07/2023] [Accepted: 09/21/2023] [Indexed: 01/16/2024] Open
Abstract
Lipoma is a common type of benign soft tissue tumor that can occur in the shoulders, neck and back, in addition to other body parts. The Retzius space is a small anatomical space between the pubic symphysis and the bladder located extraperitoneally and filled with loose fatty connective tissue. Giant lipomas are rare in the Retzius space. A 61-year-old Chinese male arrived at Beijing Yanhua Hospital (Beijing, China) due to frequent urination, and CT scan images of the lower abdomen observed a large pelvic mass and left inguinal hernia. Preoperative clinical manifestations and auxiliary examination suggested that the tumor originated from the urinary bladder wall. The maximum tumor diameter was ~25 cm and abdominal pressure was increased. Therefore, laparoscopic pelvic tumor resection combined with inguinal hernia repair was attempted. Intraoperatively, the tumor was found to originate from the Retzius space and the postoperative pathological diagnosis was lipoma. The present case report may serve as a reference for minimally invasive treatment of this type of rare disease in future.
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Affiliation(s)
- Ming-Yue Shang
- Surgery Centre of Diabetes Mellitus, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, P.R. China
| | - Li-Xin Tian
- Department of Urology, Beijing Yanhua Hospital, Beijing 102500, P.R. China
| | - Chen-Xu Tian
- Surgery Centre of Diabetes Mellitus, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, P.R. China
| | - Wei-Jian Chen
- Surgery Centre of Diabetes Mellitus, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, P.R. China
| | - Cheng-Yuan Yu
- Surgery Centre of Diabetes Mellitus, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, P.R. China
| | - Zheng Wang
- Surgery Centre of Diabetes Mellitus, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, P.R. China
| | - Jing Wang
- Surgery Centre of Diabetes Mellitus, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, P.R. China
| | - Dong-Bo Lian
- Surgery Centre of Diabetes Mellitus, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, P.R. China
| | - Guang-Zhong Xu
- Surgery Centre of Diabetes Mellitus, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, P.R. China
| | - De-Xiao Du
- Surgery Centre of Diabetes Mellitus, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, P.R. China
| | - Tian-Xiong Li
- Surgery Centre of Diabetes Mellitus, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, P.R. China
| | - Buhe Amin
- Surgery Centre of Diabetes Mellitus, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, P.R. China
| | - Neng-Wei Zhang
- Surgery Centre of Diabetes Mellitus, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, P.R. China
| | - Liang Wang
- Surgery Centre of Diabetes Mellitus, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, P.R. China
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Palacios-Jaraquemada JM, Nieto-Calvache Á, Aryananda RA, Basanta N. Placenta accreta spectrum into the parametrium, morbidity differences between upper and lower location. J Matern Fetal Neonatal Med 2023; 36:2183764. [PMID: 36966802 DOI: 10.1080/14767058.2023.2183764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
OBJECTIVE To demonstrate the surgical and morbidity differences between upper and lower parametrial placenta invasion (PPI). MATERIALS AND METHODS Forty patients with placenta accreta spectrum (PAS) into the parametrium underwent surgery between 2015 and 2020. Based on the peritoneal reflection, the study compared two types of parametrial placental invasion (PPI), upper or lower. Surgical approach to PAS follows a conservative-resective method. Before delivery, surgical staging by pelvic fascia dissection established a final diagnosis of placental invasion. In upper PPI cases, the team attempted to repair the uterus after resecting all invaded tissues or performing a hysterectomy. In cases of lower PPI, experts performed a hysterectomy in all cases. The team only used proximal vascular (aortic occlusion) control in cases of lower PPI. Surgical dissection for lower PPI started finding the ureter in the pararectal space, ligating all the tissues (placenta and newly formed vessels) to create a tunnel to release the ureter from the placenta and placenta suppletory vessels. Overall, at least three pieces of the invaded area were sent for histological analysis. RESULTS Forty patients with PPI were included, 13 in the upper parametrium and 27 in the lower parametrium. MRI indicated PPI in 33/40 patients; in three, the diagnosis was presumed by ultrasound or medical background. The intrasurgical staging categorizes 13 cases of PPI performed and finds diagnosis in seven undetected cases. The expertise team completed a total hysterectomy in 2/13 upper PPI cases and all lower PPI cases (27/27). Hysterectomies in the upper PPI group were performed by extensive damage of the lateral uterine wall or with a tube compromise. Ureteral injury ensued in six cases, corresponding to cases without catheterization or incomplete ureteral identification. All aortic vascular proximal control (aortic balloon, internal aortic compression, or aortic loop) was efficient for controlling bleeding; in contrast, ligature of the internal iliac artery resulted in a useless procedure, resulting in uncontrollable bleeding and maternal death (2/27). All patients had antecedents of placental removal, abortion, curettage after a cesarean section, or repeated D&C. CONCLUSIONS Lower PAS parametrial involvement is uncommon but associated with elevated maternal morbidity. Upper and lower PPI has different surgical risks and technical approaches; consequently, an accurate diagnosis is needed. The clinical background of manual placental removal, abortion, and curettage after a cesarean or repeated D&C could be ideally studied to diagnose a possible PPI. For patients with high-risk antecedents or unsure ultrasound, a T2 weight MRI is always recommended. Performing comprehensive surgical staging in PAS allows the efficient diagnosis of PPI before using some procedures.
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Jensen AS, Rudnicki M. Iatrogenic bladder and ureteral injuries following gynecological and obstetric surgery. Arch Gynecol Obstet 2023; 307:511-518. [PMID: 36181563 DOI: 10.1007/s00404-022-06800-0] [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] [Received: 08/01/2022] [Accepted: 09/19/2022] [Indexed: 12/01/2022]
Abstract
KEY MESSAGE Ureteral injuries are often associated with complications and risk of fistula especially in case of malignancy. Length of catheterization should be reconsidered according to the injury. PURPOSE Iatrogenic urinary tract injuries are potential complications of gynecologic and obstetric surgery. Our aim was to describe suture type and size, length of urethral catheterization, length of hospitalization, reoperation rate, follow-up, and impact on quality of life following iatrogenic bladder and ureteral injury. METHODS In total, 81 women met inclusion criteria. Bladder injuries included 55 women, ureteral injuries in 23 women, and three women had bladder and ureteral injuries. RESULTS Most bladder injuries were managed by a two-layer suture followed by transurethral catheterization for 11.4 days (95% CI 9.1-13.6). The most frequent suture type was 3.0 Vicryl in all subgroups. In total, 30.4% of ureteral injuries were managed by neoimplantation followed by ureteral stenting for 38.0 days (95% CI 22.0-54.0) and transurethral catheterization for 16.9 days (95% CI 5.3-28.4), or by ureteral stenting for 46.7 days (95% CI 31.5-61.2) and transurethral catheterization for 6.25 days (95% CI 1.0-13.5). Altogether, 25 (30.9%) women underwent a reoperation mostly due to ureteral injury (68%). In total six women developed a fistula, of whom five had malignant surgery. Multiple linear regression showed a statistically significant increased median length of urethral catheterization when the duration of surgery increased. CONCLUSIONS Our study demonstrates a high reoperation rate, and a high fistula rate in case of malignancy. Length of catheterization was high even in case of benign surgery, however, only one woman developed a fistula in the benign group, suggesting a reduction in catheterization length.
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Affiliation(s)
- Ann-Sophie Jensen
- Department of Obstetrics and Gynecology, University of Southern Denmark, Odense University Hospital, Region of Southern Denmark, Odense, Denmark
| | - Martin Rudnicki
- Department of Obstetrics and Gynecology, University of Southern Denmark, Odense University Hospital, Region of Southern Denmark, Odense, Denmark.
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Wei G, Harley F, O’Callaghan M, Adshead J, Hennessey D, Kinnear N. Systematic review of urological injury during caesarean section and hysterectomy. Int Urogynecol J 2023; 34:371-389. [PMID: 36251061 PMCID: PMC9870963 DOI: 10.1007/s00192-022-05339-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/05/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We aim to review iatrogenic bladder and ureteric injuries sustained during caesarean section and hysterectomy. METHODS A search of Cochrane, Embase, Medline and grey literature was performed using methods pre-published on PROSPERO. Eligible studies described iatrogenic bladder or ureter injury rates during caesarean section or hysterectomy. The 15 largest studies were included for each procedure sub-type and meta-analyses performed. The primary outcome was injury incidence. Secondary outcomes were risk factors and preventative measures. RESULTS Ninety-six eligible studies were identified, representing 1,741,894 women. Amongst women undergoing caesarean section, weighted pooled rates of bladder or ureteric injury per 100,000 procedures were 267 or 9 events respectively. Injury rates during hysterectomy varied by approach and pathological condition. Weighted pooled mean rates for bladder injury were 212-997 events per 100,000 procedures for all approaches (open, vaginal, laparoscopic, laparoscopically assisted vaginal and robot assisted) and all pathological conditions (benign, malignant, any), except for open peripartum hysterectomy (6,279 events) and laparoscopic hysterectomy for malignancy (1,553 events). Similarly, weighted pooled mean rates for ureteric injury were 9-577 events per 100,000 procedures for all hysterectomy approaches and pathologies, except for open peripartum hysterectomy (666 events) and laparoscopic hysterectomy for malignancy (814 events). Surgeon inexperience was the prime risk factor for injury, and improved anatomical knowledge the leading preventative strategy. CONCLUSIONS Caesarean section and most types of hysterectomy carry low rates of urological injury. Obstetricians and gynaecologists should counsel the patient for her individual risk of injury, prospectively establish risk factors and implement preventative strategies.
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Affiliation(s)
- Gavin Wei
- grid.410678.c0000 0000 9374 3516Department of Urology, Austin Health, Melbourne, Australia
| | - Frances Harley
- grid.417072.70000 0004 0645 2884Department of Urology, Western Health, Melbourne, Australia
| | - Michael O’Callaghan
- grid.1010.00000 0004 1936 7304Adelaide Medical School, University of Adelaide, Adelaide, Australia ,grid.414925.f0000 0000 9685 0624Urology Unit, Flinders Medical Centre, Bedford Park, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Flinders University, Adelaide, Australia
| | - James Adshead
- grid.415953.f0000 0004 0400 1537Lister Hospital, Stevenage, UK
| | - Derek Hennessey
- grid.411785.e0000 0004 0575 9497Department of Urology, Mercy University Hospital, Cork, Ireland
| | - Ned Kinnear
- grid.410678.c0000 0000 9374 3516Department of Urology, Austin Health, Melbourne, Australia ,grid.1010.00000 0004 1936 7304Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Jiang Z, Wang J, Meng W, Zhou Y, Ma L, Guan Y. Inhibition of Ureteral Stricture by Pirfenidone-Loaded Nanoparticle-Coated Ureteral Stents with Slow-Release Pirfenidone. Int J Nanomedicine 2022; 17:6579-6591. [PMID: 36575699 PMCID: PMC9790172 DOI: 10.2147/ijn.s390513] [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: 09/20/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Ureteral stricture caused by iatrogenic ureteral injury induced ureteral injury is more common and challenging to recover quickly. The effective prevention of ureteral stricture due to iatrogenic ureteral injury-induced ureteral damage is a current challenge for urologists. The purpose of this study was to evaluate the effectiveness of nanoparticle/pirfenidone complex-coated ureteral stents with slow-release pirfenidone for the prevention of ureteral stricture in rabbits. In this study, we developed a nanoparticle/pirfenidone complex-coated ureteral stent to deliver pirfenidone into the injured ureter to inhibit ureteral stricture. Methods Twelve New Zealand rabbits were divided into four groups: Sham, US, US+ Unmodified ureteral stent, and US+NP/PFD ureteral stent; we constructed an irreversible electroporation model of ureteral injury in rabbits and placed unmodified ureteral stents and nanoparticle/pirfenidone complex-coated ureteral stents into the ureter. Two weeks later, we euthanized the rabbits and removed their bilateral kidneys and ureters. We evaluated the effect of ureteral stent prophylaxis by gross specimen observation, section staining, and Western Blot. Results We found that the nanoparticle/pirfenidone complexes could adhere uniformly to the surface of the ureteral stent. After placement into the ureter, the nanoparticle/pirfenidone complexes were able to remain on the surface of the ureteral stent. We found nanoparticle/pirfenidone complexes could diffuse in the ureteral epithelial tissue two weeks after the order. The study showed that nanoparticle/pirfenidone complex-coated ureteral stents placed into the ureter showed significantly less stenosis due to fibrosis than in US control rabbits and rabbits treated with unmodified ureteral stents. Conclusion We used a novel platform based on nanoparticle/pirfenidone complex-coated ureteral stents for local and sustained delivery of pirfenidone, which can effectively deliver pirfenidone to the tissue and can slowly control the release of pirfenidone. Therefore, combining ureteral stents with nanoparticle/pirfenidone complexes was an effective measure to prevent ureteral stricture.
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Affiliation(s)
- Zhaosheng Jiang
- Department of Urology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, People’s Republic of China
| | - Jiahao Wang
- Department of Urology, Wuxi Hospital Affiliated to the Nanjing University of Chinese Medicine, Wuxi, People’s Republic of China
| | - Wei Meng
- Department of Urology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, People’s Republic of China
| | - Youlang Zhou
- Research Central of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, People’s Republic of China
| | - Limin Ma
- Department of Urology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, People’s Republic of China
| | - Yangbo Guan
- Department of Urology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, People’s Republic of China,Correspondence: Yangbo Guan; Limin Ma, Tel +86 18912888908; Tel +86 13404292020, Email ;
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Rahoui M, Ouanes Y, Chaker K, Mourad Dali K, Bibi M, Sellami A, Ben Rhouma S, Nouira Y. Functional outcomes of surgical treatment of ureteral injury following gynecological and obstetrical surgery. Ann Med Surg (Lond) 2022; 79:104067. [PMID: 35860075 PMCID: PMC9289392 DOI: 10.1016/j.amsu.2022.104067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 10/24/2022] Open
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Shapiro R, Sunyecz A, Zaslau S, Vallejo MC, Trump T, Dueñas-Garcia O. A Comparative Study of Braided versus Barbed Suture for Cystotomy Repair. Res Rep Urol 2021; 13:793-798. [PMID: 34805012 PMCID: PMC8594900 DOI: 10.2147/rru.s330586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/07/2021] [Indexed: 02/04/2023] Open
Abstract
Background In this study, we aim to compare outcomes after cystotomy repair between standard sutures (910 polyglactin, poliglecaprone) versus barbed (V-LocTM 90) suture. As a secondary outcome, we analyzed factors for suture preference between the two groups. Methods A retrospective chart review was undertaken for surgeries complicated by cystotomy, identified by ICD-9/10 codes from 2016 to 2019 at West Virginia University (WVU) Hospital. Comparisons were made between cystotomy repair using barbed suture versus standard braided suture. Injuries were categorized by procedure, surgical route, type of suture used in repair, and subsequent complications related to repair. Primary endpoints were examined by Pearson's Chi-square test and interval data by t-test. A p < 0.05 was significant. Results Sixty-eight patients were identified with iatrogenic cystotomy at WVU. Barbed suture was used for cystotomy repair in 11/68 (16.2%) patients. No significant difference was seen in postoperative outcomes between patients repaired with barbed suture versus standard braided suture. Barbed suture was significantly more likely to be used for cystotomy repair in minimally invasive surgery (p = 0.001). It was most often utilized in a robotic approach 7/11 (63.6%) followed by laparoscopic 3/11 (27.3%). Body mass index (BMI) was significantly higher in patients receiving a barbed suture repair (p = 0.005). Conclusion Barbed suture may be comparable to standard braided suture for cystotomy repair. Barbed suture may offer a practical alternative to facilitate cystotomy repair in minimally invasive surgery, especially in patients with a high BMI.
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Affiliation(s)
- Robert Shapiro
- Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA.,Department of Urology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Alec Sunyecz
- West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Stanley Zaslau
- Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA.,Department of Urology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Manuel C Vallejo
- Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA.,Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Tyler Trump
- Department of Urology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Omar Dueñas-Garcia
- Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
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Safrai M, Stern S, Gofrit ON, Hidas G, Kabiri D. Urinary tract injuries during cesarean delivery: long-term outcome and management. J Matern Fetal Neonatal Med 2020; 35:3547-3554. [PMID: 33016166 DOI: 10.1080/14767058.2020.1828336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Urinary tract injury during cesarean delivery is a rare but severe complication. Due to the high prevalence of cesarean delivery, this injury may pose a high burden of morbidity. We reviewed the cases of lower urinary tract injuries identified during cesarean delivery in a tertiary medical center and identified diagnosis and treatment methods, as well as short and long-term outcomes, to establish a protocol of care for such cases. METHODS We included women with urinary tract injury during cesarean delivery between 2004 and 2018. The cases were identified according to ICD-9 codes, as well as free text in the medical report and discharge letter. Data were collected retrospectively. Telephone interviews were conducted to obtain additional data regarding long-term outcomes. RESULTS In14 years, a total of 17,794 cesarean deliveries were performed at our institution (17.5% of all deliveries), 14 cases of bladder injury, and 11 cases of ureteral injury were identified featuring an incidence of 0.08 and 0.06%, respectively. All bladder injuries were diagnosed and repaired intra-operatively. Six (55%) cases of ureteral injury were diagnosed in the post-operative period, and 3 of these patients required further surgery for definitive treatment. None of the patients suffered long-term adverse effects. Most bladder injuries occurred in women with previous cesarean delivery in the presence of abdominal adhesions. In contrast, most ureteral injuries occurred in women with emergency cesarean delivery during the second stage of labor, and were accompanied by an extension of the uterine incision. All women had normal kidney function in follow up and did not suffer from long term sequelae. CONCLUSION Urinary tract injury is an uncommon complication of cesarean delivery. A high index of suspicion is recommended to avoid late diagnosis and complications. We propose a comprehensive protocol for the management of these injuries.
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Affiliation(s)
- Myriam Safrai
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shira Stern
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Doron Kabiri
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Naicker S, Naidoo TD, Moodley J. Obstetric-associated lower urinary tract injuries: A case series from a tertiary centre in a low-resource setting. Case Rep Womens Health 2020; 27:e00218. [PMID: 32695613 PMCID: PMC7360976 DOI: 10.1016/j.crwh.2020.e00218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/05/2020] [Indexed: 10/24/2022] Open
Abstract
Obstetric-associated lower urinary tract injuries may occur during vaginal and abdominal deliveries. If these injuries go unrecognised, these patients may suffer both physical and psychosocial complications. We describe the management of 19 patients with such injuries, including their demographic profile, associated factors, and complications at a tertiary institution in a retrospective case series over a 5-year period. Bladder injuries were the most common (89.5%), mostly occurring during emergency caesarean delivery, with previous caesarean delivery and adhesions being risk factors. A primary repair was attempted at the referring institution in 35.7% of cases. Repair at the tertiary institution was mostly performed by consultants (42.9%). Early recognition and primary repair are found to reduce further complications.
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Affiliation(s)
- Shantel Naicker
- Department of Obstetrics and Gynaecology, Greys Hospital, Pietermaritzburg and Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Thinagrin D Naidoo
- Department of Obstetrics and Gynaecology, Greys Hospital, Pietermaritzburg and Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Jagidesa Moodley
- Department Obstetrics and Gynaecology and Women's Health and HIV Research Group, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
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Yellinek S, Krizzuk D, J Nogueras J, D Wexner S. Ureteral Injury During Colorectal Surgery: Two Case Reports and a Literature Review. JOURNAL OF THE ANUS RECTUM AND COLON 2018; 2:71-76. [PMID: 31559346 PMCID: PMC6752145 DOI: 10.23922/jarc.2017-052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/09/2018] [Indexed: 12/15/2022]
Abstract
Iatrogenic ureteral injury (IUI) is a dreaded complication of abdominopelvic surgery. Although rare, it is associated with severe consequences. This complication most commonly occurs during gynecological procedures but may also occur during colorectal surgeries. We present two cases of IUI in patients in whom the ureteric stents were electively placed. The first case was a 71-year-old male with no significant medical history. The patient underwent an elective laparoscopic sigmoidectomy for complicated diverticulitis. During the procedure, a proximal IUI occurred, and was recognized and repaired. The second case occurred in a 68-year-old male with a history of multiple complicated abdominal surgeries. The patient underwent a second redo low anterior resection for a long preanastomotic stricture. The IUI occurred in the right fibrosed presacral plane, approximately 3 cm proximal to the bladder. The ureter was reimplanted to the bladder during the same procedure. We will also present a literature review of IUI, including the risk factors, intraoperative prevention, and repair options.
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Affiliation(s)
- Shlomo Yellinek
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL
| | - Dimitri Krizzuk
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL
| | - Juan J Nogueras
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL
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12
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Raassen TJIP, Ngongo CJ, Mahendeka MM. Diagnosis and management of 365 ureteric injuries following obstetric and gynecologic surgery in resource-limited settings. Int Urogynecol J 2017; 29:1303-1309. [PMID: 29022054 PMCID: PMC6132689 DOI: 10.1007/s00192-017-3483-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 09/09/2017] [Indexed: 11/26/2022]
Abstract
Introduction Ureteric injuries are among the most serious complications of pelvic surgery. The incidence in low-resource settings is not well documented. Methods This retrospective review analyzes a cohort of 365 ureteric injuries with ureterovaginal fistulas in 353 women following obstetric and gynecologic operations in 11 countries in Africa and Asia, all low-resource settings. The patients with ureteric injury were stratified into three groups according to the initial surgery: (a) obstetric operations, (b) gynecologic operations, and (c) vesicovaginal fistula (VVF) repairs. Results The 365 ureteric injuries in this series comprise 246 (67.4%) after obstetric procedures, 65 (17.8%) after gynecologic procedures, and 54 (14.8%) after repair of obstetric fistulas. Demographic characteristics show clear differences between women with iatrogenic injuries and women with obstetric fistulas. The study describes abdominal ureter reimplantation and other treatment procedures. Overall surgical results were good: 92.9% of women were cured (326/351), 5.4% were healed with some residual incontinence (19/351), and six failed (1.7%). Conclusions Ureteric injuries after obstetric and gynecologic operations are not uncommon. Unlike in high-resource contexts, in low-resource settings obstetric procedures are most often associated with urogenital fistula. Despite resource limitations, diagnosis and treatment of ureteric injuries is possible, with good success rates. Training must emphasize optimal surgical techniques and different approaches to assisted vaginal delivery.
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Occurrence of and Risk Factors for Urological Intervention During Benign Hysterectomy: Analysis of the National Surgical Quality Improvement Program Database. Urology 2016; 97:66-72. [DOI: 10.1016/j.urology.2016.06.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 06/14/2016] [Accepted: 06/23/2016] [Indexed: 11/19/2022]
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Başaranoğlu S, Deregözü A, Köroğlu N, Kalkan M, Şahin C, Kadanalı S. Early and Late Diagnosis of Iatrogenic Urinary Tract Injuries During Obstetric and Gynecological Operations. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2016. [DOI: 10.5799/jcei.328617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Les fistules uro-génitales iatrogènes: À propos de 62 cas et revue de la littérature. AFRICAN JOURNAL OF UROLOGY 2016. [DOI: 10.1016/j.afju.2015.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Rashid TG, Revicky V, Terry TR. Caesarean bladder and ureteric injuries in the UK. JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415814533108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lower segment caesarean section (LSCS)-related lower urinary tract injuries are rare. The incidence is rising because of the increasing number of LCSCs being performed. In this review, we classify such injuries into three types and outline their management.
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Andersen P, Andersen LM, Iversen LH. Iatrogenic ureteral injury in colorectal cancer surgery: a nationwide study comparing laparoscopic and open approaches. Surg Endosc 2014; 29:1406-12. [DOI: 10.1007/s00464-014-3814-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 08/14/2014] [Indexed: 01/21/2023]
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Ureteral injuries in colorectal surgery: an analysis of trends, outcomes, and risk factors over a 10-year period in the United States. Dis Colon Rectum 2014; 57:179-86. [PMID: 24401879 DOI: 10.1097/dcr.0000000000000033] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Iatrogenic ureteral injuries during colorectal surgical procedures are rare. Little is known about their incidence, associated outcomes, and predisposing factors. OBJECTIVE The purpose of this study was to examine the trends of iatrogenic ureteral injuries in the United States over a decade, as well as their outcomes and risk factors. DESIGN This was a retrospective study. SETTINGS The nationwide inpatient sample from 2001 to 2010 was analyzed. PATIENTS Included were patients with colorectal cancer, benign polyps, diverticular disease, or inflammatory bowel disease undergoing colorectal surgery. MAIN OUTCOME MEASURES Trends of iatrogenic ureteral injuries occurring in colon and rectal surgical procedures were examined over a 10-year period. Mortality, morbidity, length of stay and total charge associated with ureteral injuries were analyzed on multivariate analysis. Finally, a predictive model for ureteral injuries was built using patient, hospital, and operative variables. RESULTS An estimated 2,165,848 colorectal surgical procedures were performed in the United States over the study period, and 6027 ureteral injuries were identified (0.28%). The rate of ureteral injuries was higher in the second half of the decade (2006-2010) compared with the first half (2001-2005; 3.1/1000 vs 2.5/1000; p < 0.001). Ureteral injuries were independently associated with higher mortality (OR, 1.45; p < 0.05), morbidity (OR, 1.66; p < 0.001), longer length of stay (mean difference, 3.65 days; p < 0.001), and higher hospital charges by $31,497 (p< 0.001). Risk factors for ureteral injuries included rectal cancer (OR, 1.85), adhesions (OR, 1.83), metastatic cancer (OR, 1.76), weight loss/malnutrition (OR, 1.08), and teaching hospitals (OR, 1.05). Protective factors included the use of laparoscopy (OR, 0.91), transverse colectomy (OR, 0.90), and right colectomy (OR, 0.43). LIMITATIONS This was a retrospective study from an administrative database. CONCLUSIONS Iatrogenic ureteral injuries are rare complications in colorectal surgery; however, their incidence appears to be rising. Ureteral injuries are associated with higher mortality, morbidity, hospital charge, and length of stay, and their incidence can be predicted by several factors.
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Yu S, Wu H, Xu L, Li G, Zhang Z. Early surgical repair of iatrogenic ureterovaginal fistula secondary to gynecologic surgery. Int J Gynaecol Obstet 2013; 123:135-8. [DOI: 10.1016/j.ijgo.2013.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/15/2013] [Accepted: 07/23/2013] [Indexed: 11/29/2022]
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Papanikolaou A, Tsolakidis D, Theodoulidis V, Ioannidis E, Vatopoulou A, Kellartzis D. Surgery for ureteral repair after gynaecological procedures: a single tertiary centre experience. Arch Gynecol Obstet 2012; 287:947-50. [DOI: 10.1007/s00404-012-2659-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 11/23/2012] [Indexed: 10/27/2022]
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