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Fuquan J, Gang Z, Jianlin X, Yin R. Complete ureteral necrosis after injury sustained during lumbar disc surgery: A case report. Medicine (Baltimore) 2020; 99:e21727. [PMID: 32872054 PMCID: PMC7437836 DOI: 10.1097/md.0000000000021727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Reports pertaining to ureteral injury sustained during lumbar disc surgery are rare; most ureteral injuries in this setting involve laceration or transection. PATIENT CONCERNS We report a rare case of a 55-year-old man who presented with complete left ureteral necrosis 20 days after sustaining ureteral transection during lumbar disc surgery. DIAGNOSIS The patient presented with seroperitoneum caused by left ureteral injury; post-operative histopathological examination of surgical specimen after discectomy had revealed ureter-like tissue. Exploratory laparoscopic surgery revealed necrosis of a long segment of ureter, which was not amenable to treatment with conventional methods. INTERVENTION We used a spiral bladder muscle flap with vascular pedicles to repair the ureteral defect. OUTCOMES Post-operative period was uneventful and the patient showed good recovery. CONCLUSION Spiral bladder muscle flap with vascular pedicles may be used to repair extensive ureteric injury.
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Affiliation(s)
| | | | - Xiao Jianlin
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ruofeng Yin
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
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Turgut M, Turgut AT, Dogra VS. Iatrogenic Ureteral Injury as a Complication of Posterior or Lateral Lumbar Spine Surgery: A Systematic Review of the Literature. World Neurosurg 2019; 135:280-296. [PMID: 31887462 DOI: 10.1016/j.wneu.2019.12.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/18/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Iatrogenic ureteral injury associated with lumbar spine surgery is an uncommon but devastating complication with associated medicolegal implications. METHODS We performed a systematic review of the English language literature published between 1954 and 2019, accessed through 4 popular databases. We found 44 articles (28 case reports, 9 case-based reviews, 4 case series, 1 original article, 1 case illustration, and 1 pictorial) containing 46 cases of ureteral injuries after posterior or lateral lumbar spine surgery. RESULTS Except for 5 cases with insufficient data, 24 of the remaining 41 patients were female and 17 were male, with ages ranging from 16 years to 83 years. Excluding 4 cases without enough information, initial diagnoses of lumbar disc herniation (n = 33) or lumbar spinal stenosis (n = 4), spondylolisthesis (n = 3), degenerative disc disease (n = 1), and failed back surgery syndrome (n = 1) were reported from 18 countries; 54% of patients were from the United States, Japan, or Turkey. The interval from spinal surgery to restorative surgery ranged from <24 hours to 1 month to 1 year; in 48% of patients, it was >1 week, and 90% of patients recovered completely. Initial surgery was combined with vascular injury in 15% of patients. CONCLUSIONS Ureteral injury associated with lumbar spine surgery is overreported in developed or developing countries. It should be considered in the differential diagnosis of any patient who presents with symptoms of acute abdomen after lumbar spine surgery, and patients who underwent restorative surgery had a good prognosis.
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Affiliation(s)
- Mehmet Turgut
- Department of Neurosurgery, Aydın Adnan Menderes University Faculty of Medicine, Efeler, Aydın, Turkey
| | - Ahmet Tuncay Turgut
- Department of Radiology, Yüksek İhtisas University Faculty of Medicine, Balgat, Ankara, Turkey.
| | - Vikram S Dogra
- Department of Imaging Sciences, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, New York, USA
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Mogorovich A, Selli C, De Maria M, Manassero F, Durante J, Urbani L. Clinical reappraisal and state of the art of nephropexy. Urologia 2018; 85:135-144. [PMID: 29637838 DOI: 10.1177/0391560317749191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The diffusion of minimally invasive techniques for renal surgery has prompted a renewed interest in nephropexy which is indicated to prevent nephroptosis in symptomatic patients and to mobilize the upper ureter downward in order to bridge a ureteral defect. Recent publications have been reviewed to present the state of the art of the diagnosis and management of these two challenging conditions and to try to foresee the next steps. The evaluation of patients with mobile kidney can be made relying on diagnostic criteria such as ultrasound with color Doppler and measurement of resistive index, conventional upright X-ray frames after a supine uro-computerized tomography scan and both static and dynamic nuclear medicine scans, always with evaluation in the sitting or erect position. Laparoscopic nephropexy emerges as the current treatment option combining both objectively controlled repositioning of the kidney and resolution of symptoms with minimal invasiveness, low morbidity, and short hospital stay. The use of robotics is presently limited by its higher cost, but may increase in the future. Downward renal mobilization and nephropexy is a safe and versatile technique which has been adopted as a unique strategy or more often in combination with other surgical maneuvers in order to cope with complex ureteral reconstruction.
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Affiliation(s)
- Andrea Mogorovich
- 1 Division of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Cesare Selli
- 1 Division of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Maurizio De Maria
- 1 Division of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Francesca Manassero
- 1 Division of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Jacopo Durante
- 1 Division of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Lucio Urbani
- 2 Department of Surgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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An Unusual Case of Ureteral Perforation in Minimally Invasive Pedicle Screw Instrumentation: Case Report and Review of the Literature. World Neurosurg 2018; 111:28-35. [DOI: 10.1016/j.wneu.2017.11.175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 11/23/2022]
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Wijaya T, Lo TS, Jaili SB, Wu PY. The diagnosis and management of ureteric injury after laparoscopy. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2015.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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6
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Lee Z, Llukani E, Reilly CE, Mydlo JH, Lee DI, Eun DD. Single Surgeon Experience with Robot-Assisted Ureteroureterostomy for Pathologies at the Proximal, Middle, and Distal Ureter in Adults. J Endourol 2013; 27:994-9. [DOI: 10.1089/end.2013.0075] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Ziho Lee
- Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Elton Llukani
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Christopher E. Reilly
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Jack H. Mydlo
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - David I. Lee
- Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Daniel D. Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
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Knight RB, Hudak SJ, Morey AF. Strategies for open reconstruction of upper ureteral strictures. Urol Clin North Am 2013; 40:351-61. [PMID: 23905933 DOI: 10.1016/j.ucl.2013.04.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article presents a review of the literature regarding surgical techniques and outcomes for reconstruction of strictures involving the upper ureter. The preoperative assessment for proximal ureteral stricture is briefly reviewed, followed by a discussion of ureteroureterostomy, transureteroureterostomy, ureterocalicostomy, bladder flaps, downward nephropexy, bowel interposition grafts, onlay or tubular grafting, renal autotransplantation, and nephrectomy. The future direction for reconstruction of the proximal ureter is proposed.
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Affiliation(s)
- Richard B Knight
- Department of Urology, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, TX 78234, USA.
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Abstract
Although ureteric injury is relatively uncommon, it is a serious event that can result in intra-abdominal sepsis, renal failure, and loss of the ipsilateral renal unit. Most injuries are iatrogenic and remain undiagnosed until the patient presents with symptoms postoperatively. In addition to compromising patient safety, missed ureteric injuries frequently result in litigation. Over the past 20 years, there has been a rapid uptake of laparoscopic and robotic techniques within urology and other surgical specialties. This trend, coupled with increased use of ureteroscopy, has increased the risk of injury to the ureter. The key to diagnosing and managing a ureteric injury is to have a low threshold for suspecting its presence. Diagnosis can be achieved using retrograde pyelography, ureteroscopy, CT, or intravenous urography. Initial management should involve ureteric stent placement or percutaneous nephrostomy drainage. In selected patients, surgical reconstruction might be the optimal approach. Decisions regarding surgical technique (open, laparoscopic, or robotic) are guided by the clinical situation and surgical expertise available.
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Double-J stenting: initial management of injured ureters recognized late after gynecological surgery. Int Urogynecol J 2010; 21:699-703. [DOI: 10.1007/s00192-009-1092-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 12/27/2009] [Indexed: 11/25/2022]
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Ureteric injury after lumbosacral discectomy: a case report and review of the literature. ACTA ACUST UNITED AC 2008; 64:1387-91. [PMID: 18469666 DOI: 10.1097/ta.0b013e31816bbe4c] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Herein, a case of ureteric injury was inflected during lumbo-sacral laminectomy is reported to be added to the previously published 15 cases. Ureteric injury is a rare complication that may be encountered during lumbar disc surgery. We traced 15 cases that were published in literatures allover the past years with different management techniques. To the best of our knowledge, we report the first case that was treated by ileal ureteric replacement. Special attention should be paid regarding ureteric injury during surgery. Despite rare incidence of such injury with laminectomy, there were some reportable complications. So, surgeons should be aware of prediction, early diagnosis, and possible management alternatives for such injuries to safe patients from unsuspected handicapping.
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Pokala N, Delaney CP, Kiran RP, Bast J, Angermeier K, Fazio VW. A randomized controlled trial comparing simultaneous intra-operative vs sequential prophylactic ureteric catheter insertion in re-operative and complicated colorectal surgery. Int J Colorectal Dis 2007; 22:683-7. [PMID: 17031654 DOI: 10.1007/s00384-006-0219-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2006] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Prophylactic insertion of ureteric stents aids intra-operative identification of ureters and may allow easier visualization of any direct ureteric injury. Traditionally, ureteric catheters are inserted sequentially, before starting the abdominal part of the operation. This study determines the safety and efficacy of simultaneous intra-operative ureteric catheter insertion during complicated and re-operative colorectal surgery. MATERIALS AND METHODS After institutional review board (IRB) approval, 24 patients were randomized into two groups, sequential (SEQ) and simultaneous (SIM) depending upon the timing of stent placement relative to abdominal incision. Time taken from induction to abdominal incision (AIT), induction to peritoneal entry (PET), catheter insertion time (CIT), and urinary tract infection rates were recorded. Degree of difficulty for stent insertion was graded on a scale of 1-10. RESULT Demographics were similar between groups. Mean AIT (22 +/- 4 vs 41 +/- 7; p = 0.0001) and mean PET (26 +/- 4.2 vs 44 +/- 7.6; p = 0.0001) were shorter in the SIM group. There was no significant difference in mean CIT in SIM and SEQ groups (17.9 +/- 4.9 vs 17.6 +/- 5.9 min, p = 0.8). The stents were unsuccessful bilaterally in one patient in the SEQ group and unilaterally in two other patients, one in each group. The median difficulty score for catheter insertion was 3 (1-10) and 2 (1-10), (p = 0.12), respectively, in SIM and SEQ groups. There were no ureteric injuries in either group. One patient in SIM developed a urinary tract infection. CONCLUSION Simultaneous ureteric catheter insertion during abdominal procedures reduces operating times without a significant increase in morbidity. Furthermore, this permits a policy of selective stent insertion as required by the intra-abdominal findings after laparotomy.
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Affiliation(s)
- Naveen Pokala
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Paick JS, Hong SK, Park MS, Kim SW. Management of postoperatively detected iatrogenic lower ureteral injury: should ureteroureterostomy really be abandoned? Urology 2006; 67:237-41. [PMID: 16442604 DOI: 10.1016/j.urology.2005.08.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Revised: 07/26/2005] [Accepted: 08/17/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To reevaluate the role of ureteroureterostomy in the management of postoperatively detected iatrogenic lower ureteral injury. Despite the advantages of preserving the integrity of bladder and the natural antireflux mechanism, open end-to-end ureteroureterostomy is rarely performed today for treatment of lower ureteral injury diagnosed postoperatively. METHODS A retrospective analysis was performed of 9 patients (all women, mean age 49.2 years) who had received end-to-end ureteroureterostomy from 1998 to 2002 for postoperatively detected iatrogenic lower ureteral injuries sustained during gynecologic or general surgery. RESULTS All patients had the intact distal ureteral stumps identified by retrograde pyelography before undergoing ureteroureterostomy. Open end-to-end ureteroureterostomies with double-J catheter stenting were performed as soon as the diagnosis had been made (interval from injury to repair 10 days to 21 weeks). The mean length of the eventually resected segments of the injured lower ureter was 2.7 cm, and the mean distance between the distal margin of the injured ureteral segment and the ureterovesical junction measured intraoperatively was 2.9 cm. Renal mobilization was required in 1 patient. In 1 patient who had a bilateral ureteral injury, ureteroureterostomy was performed on only one side, with a psoas hitch on the contralateral side. In all cases, the initially observed hydronephrosis and fistula disappeared after surgery, and no complications were observed during a mean follow-up of 33.7 months (range 6 to 55). CONCLUSIONS Ureteroureterostomy may still be considered a realistic treatment option in the case of postoperatively detected iatrogenic lower ureteral injuries with distal ureteral stumps preserved and identified on retrograde pyelography.
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Affiliation(s)
- Jae-Seung Paick
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
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Brandes S, Coburn M, Armenakas N, McAninch J. Diagnosis and management of ureteric injury: an evidence-based analysis. BJU Int 2004; 94:277-89. [PMID: 15291852 DOI: 10.1111/j.1464-410x.2004.04978.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Steven Brandes
- Department of Surgery (Urology), School of Medicine, Washington University Medical Center, 4960 Children's Place, St. Louis, MO 63110, USA.
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Rafique M, Arif MH. Management of iatrogenic ureteric injuries associated with gynecological surgery. Int Urol Nephrol 2003; 34:31-5. [PMID: 12549636 DOI: 10.1023/a:1021320409583] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This retrospective study defines the presentation and management of iatrogenic ureteric injuries consequent upon gynecological surgery in a teaching hospital in Punjab, Pakistan. PATIENTS AND METHODS 18 patients with median age 35 years (range 18-80 years) with iatrogenic ureteric injuries associated with gynecological surgery were referred to the department of urology at Nishtar Hospital Multan Pakistan. Main presenting symptoms were urinary incontinence, loin pain and anuria. Median time since injury and presentation was 3 weeks (range 1 day to 7 years). In 16 (88%) patients injury resulted from abdominal hysterectomy. Other causes included ovarian cystectomy (one patient) and vaginal hysterectomy (one patient). 11 (61%) patients had ureterovaginal fistula, 5 (28%) patients had complete unilateral ureteric obstruction and 2 (11%) patients had bilateral ureteric obstruction and anuria. In 11 patients with ureterovaginal fistula ureteroneocystostomy was performed. In five patients with unilateral ureteric obstruction, one had end to end anastomosis of ureter, three had ureteroneocystostomy only and one had ureteroneocystostomy and psoas hitch done. Two had anuria secondary to bilateral ureteric obstruction. In one of these patients Boari flap and ureteroneocystostomy was carried out. The second patient had deligation of catgut sutures on ipsilateral side and ureteroneocystostomy on the contra-lateral side. RESULTS In 17 patients no major complication occurred. One patient who had deligation of catgut sutures, the distal ureter sloughed and re-exploration and ureteroneocystostomy was performed. Renal salvage was achieved in all cases. CONCLUSION Open surgical procedures for repair of iatrogenic ureteric injuries are associated with good outcome. Strategies to prevent these injuries include adequate surgical training and meticulous surgical techniques.
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Flores-Carreras O, Cabrera JR, Galeano PA, Torres FE. Fistulas of the urinary tract in gynecologic and obstetric surgery. Int Urogynecol J 2002; 12:203-14. [PMID: 11451010 DOI: 10.1007/s001920170065] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Iatrogenic injury is always an unwelcome event at the time of surgery. Prior history of multiple laparatomies, radiation therapy, or a distorted pelvic anatomy caused by a malignancy are all factors that may make iatrogenic injury a likely event. In these situations, complications at times can be considered unavoidable. Injuries during benign surgical procedures also can be difficult to manage, especially if not diagnosed at the time of occurrence. Operative knowledge to manage the more commonly encountered complications must be in the repertoire of all surgeons, including those dealing with abdominopelvic malignancies. This article reviews the more common genitourinary, gastrointestinal, and neural injuries encountered during gynecological surgical procedures and discusses basic management strategies.
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Affiliation(s)
- L E Mendez
- Department of Obstetrics and Gynecology, Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center, University of Miami, Florida 33136, USA
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Abstract
Nearly all gynecological procedures have been reported to cause ureteric injury, with an incidence of 0.4%-2.5% for non-malignant conditions. The incidence is rising as more ambitious operations are undertaken laparoscopically. Risk factors for ureteric injury include cancer, hemorrhage, endometriosis, adhesions and an enlarged uterus. Types of injury include ligation, crush, laceration, avulsion, stretch and devascularization. The diagnosis may be obvious intraoperatively, but postoperative presentation with loin pain, pyrexia, fistula or non-specific signs is more common. A significant number are asymptomatic. Early diagnosis is vital, and urological investigation should be considered in any patient who is not recovering as expected. Injuries recognized intraoperatively should be repaired during the same operation. Delayed recognized injuries are being managed conservatively with increasing success in selected cases. Early operative repair achieves good results unless the injury is severe. Litigation is less likely if the diagnosis is prompt, repair is successful and the patient is treated with consideration.
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Affiliation(s)
- M J Drake
- Churchill Hospital, Headington, Oxford, UK
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Abstract
PURPOSE The psoas hitch ureteral reimplant has been described in the literature as an excellent method to restore ureterovesical continuity in patients with ureteral defects of various etiologies. However, long-term data on the durability of this procedure are lacking. We retrospectively reviewed patients who underwent ureteral reconstruction using the psoas hitch reimplantation to determine long-term efficacy. MATERIALS AND METHODS Ureteral reimplantation in the adult is frequently performed in the setting of ureteral tissue loss secondary to resection or injury. The psoas hitch reimplantation is a simple, versatile technique that avoids the inclusion of intestinal segments and can be used in most patients requiring reimplantation. Indications for surgery and the long-term followup were examined in 20 patients undergoing reimplantation using the psoas hitch. RESULTS The indications for ureteral reconstruction included surgical injury in 13 cases, recurrent pyelonephritis with reflux in 1, obstruction secondary to cancer in 2, trauma in 1, retroperitoneal fibrosis in 1 and ureteral stricture in 2. At followup of 1 to 14 years (mean 6) 17 patients have not required further intervention for urological problems and have retained normal renal function. In the 2 patients with cancer ileal conduit was performed later and in 1 flank pain persisted despite negative urological evaluation. CONCLUSIONS Psoas hitch ureteral reimplantation can be used successfully for bridging various ureteral defects in difficult clinical situations. Adequate renal and bladder mobilization will allow reconstruction despite long ureteral defects.
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Affiliation(s)
- R Mathews
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Abstract
PURPOSE We reviewed the causes, treatment and morbidity associated with iatrogenic ureteral injuries. MATERIALS AND METHODS From 1972 to 1992 the charts of all patients with the diagnosis of iatrogenic ureteral injury were reviewed and 156 injuries were identified. RESULTS Urological, gynecological and general surgical procedures accounted for 70 (42%), 56 (34%) and 39 (24%) injuries, respectively. Of the injuries 91% occurred in the lower third, 7% in the middle third and 2% in the upper third of the ureter, respectively. Among the urological lesions 77% were identified at injury compared to only 33% of the nonurological cases. Nonurological and urological ureteral injuries detected postoperatively required 1.8 and 1.6 procedures, respectively, compared to only 1.2 procedures in both groups (p < 0.0006 and p < 0.013) when the injuries were detected immediately at operation. CONCLUSIONS Endourological procedures are the most common cause of iatrogenic ureteral injuries. When identified at injury and treated properly such injuries seldom lead to loss of renal function.
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Affiliation(s)
- A A Selzman
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Senagore AJ, Luchtefeld M. An initial experience with lighted ureteral catheters during laparoscopic colectomy. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1994; 4:399-403. [PMID: 7881143 DOI: 10.1089/lps.1994.4.399] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Ureteral catheters are recommended when a difficult pelvic dissection is anticipated to minimize the risk of ureteral injuries. With the introduction of laparoscopic-assisted colectomy, it has become necessary to replace tactile with visual feedback. Lighted ureteral catheters (LUC) have been advocated for major laparoscopic pelvic surgery as a means of enhancing ureteral identification. However, the use of LUC has been anecdotal to this point. We present the first series of selectively used LUC during laparoscopic-assisted colectomy. Forty-nine consecutive laparoscopic-assisted colectomies were reviewed in which patients had LUC placed or not (NC) [LUC,24(49%); NC, 25(51%)]. Indications for catheter insertion included complicated diverticular disease, previous pelvic surgery, and obesity. The need for LUC was at the discretion of the surgeon. Data collected included catheter visualization, type of procedure, operative time, operating room cost, and catheter or ureteral complications. Catheters were visualized in 5 of 6 (83%) right colectomies and 15 of 18 (83%) left colectomies. Nonvisualization was because of migration to the bladder (2 cases) and dense inflammatory reaction (2 cases). No catheter complications or ureteral injuries occurred in either group. Operative time (LUC, 192 +/- 11.3 min, NC, 161.4 +/- 9.5 min) was significantly longer in the LUC group as a result of the time for catheter insertion and the greater complexity of the case. The operating room cost was similar in the two groups (LUC, $3488.63 +/- 259.01; NC, $3537.56 +/- 313.43). The results indicate that selected use of LUC does significantly increase operating time without significantly increasing operating room cost or operative morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A J Senagore
- Ferguson-Blodgett Digestive Disease Institute, Grand Rapids, Michigan
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Mate-Kole MO, Yeboah ED, Affram RK, Ghosh TS. Anuric acute renal failure due to bilateral accidental ureteric ligation during abdominal hysterectomy. Int J Gynaecol Obstet 1993; 41:67-73. [PMID: 8098298 DOI: 10.1016/0020-7292(93)90156-q] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the incidence of accidental ureteric ligation causing acute anuric renal failure (AARF) at the KorleBu Teaching Hospital, Accra, Between August 1984 and December 1991. METHOD The records and operative data of all cases managed with acute anuric renal failure at the hospital during the period were reviewed. RESULT The 7 patients with AARF presented with mean pre-referral anuria of 3.2 days. Total abdominal hysterectomy (4 for fibroids, 2 for carcinoma of uterus and 1 for post partum hemorrhage) was the cause of ureteric ligation. The 7 patients mean age 38.5 years were anemic (mean HB 4.1 g/dl) and uremic (mean blood urea 40.51 mmol/l) on admission. Abdominal ultrasonography was useful for diagnosis of obstructive uropathy. Hemodialysis was required in all cases prior to laparotomy and ureteroneocystostomy. The ureters were usually ligated at the distal 3 cm. Five survived ureteroneocystostomy and 2 died before laparatomy from septicemia and/or pulmonary edema. CONCLUSION Abdominal hysterectomy is a major cause of anuric acute renal failure and early recognition and treatment prevents death.
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Affiliation(s)
- M O Mate-Kole
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra
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Abstract
We present a simple technique for intraoperative stenting of a transected ureter. This method does not require cystoscopy, or a separate incision in the bladder or skin.
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Affiliation(s)
- J G Barone
- Division of Urology, University of Medicine and Dentistry, Robert Wood Medical School, New Brunswick, New Jersey 08903-0019
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Abstract
Iatrogenic ureteral injuries in vascular reconstructive surgery are rarely reported. We present a case of ureteral transection during repair of an aortic aneurysm in a patient with a previously placed aortobifemoral graft. In reported series of surgical ureteral injuries, 17 of 381 injuries occurred during vascular procedures. A review of the literature and management scheme for ureteral complications in the presence of prosthetic vascular grafts is presented in light of current endourologic materials and techniques.
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Affiliation(s)
- J R Adams
- Department of Urology, Louisiana State University Medical Center, Shreveport
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Affiliation(s)
- M A St Lezin
- Department of Urology, University of California School of Medicine, San Francisco
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27
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Abstract
In this article, we have reviewed the scope of surgically induced damage to the lower urinary tract. Preventative and reparative techniques have been presented. As pelvic surgeons become more confident in their efforts to safeguard the urinary tract, the chance of an unrecognized injury causing morbidity will diminish.
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Affiliation(s)
- L T Brubaker
- Department of Obstetrics and Gynecology, Rush Medical College, Chicago, Illinois
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DiCostanzo GA, Kalman PG, Trachtenberg J. Erosion of the ureter by ileofemoral arterial prosthesis. J Vasc Surg 1988. [DOI: 10.1016/0741-5214(88)90410-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
We treated 27 patients with iatrogenic ureteral injuries during a 6-year period. Gynecological operations were the most common antecedent surgical procedures (52 per cent). The diagnosis of ureteral injury was made immediately in 4 patients and was delayed 1 to 34 days in 23. Three of the 4 injuries recognized during an operation were repaired successfully at the time of injury; the primary repair in the remaining patient leaked and ultimately resulted in a nephrectomy. In the delayed diagnosis group retrograde ureteral catheterization was successful in only 1 of 20 attempts. Of the 23 patients with injuries recognized in the postoperative period 11 were managed successfully with percutaneous nephrostomy (with or without stenting) alone, 3 required surgical repair after temporary percutaneous nephrostomy drainage, 4 were treated surgically without prior nephrostomy drainage and 1 had spontaneous resolution of hydronephrosis. The remaining 3 patients required nephrectomy: 1 because of a urinary fistula in a previously irradiated field, 1 because of a concomitant (ipsilateral) renal cell carcinoma and 1 because of renal hypertension. Percutaneous nephrostomy or ureteral stenting was successful as primary therapy in 73 per cent of the patients in whom it was used.
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