Mild hydronephrosis after uncomplicated hysterectomy

Delayed postrenal failure due to progression of asymptomatic hydronephrosis following hysterectomy

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.

Detection rate with routine postoperative renal ultrasound to identify urinary tract injury after gynecological surgery

PURPOSE

The aim of this study was to establish the rate at which routine postoperative renal ultrasonography is able to detect urinary tract injury following gynecological surgery.

METHODS

A retrospective analysis was carried out for the study period 2015-2019 of all patients who had undergone subtotal or total hysterectomy, or radical hysterectomy or salpingectomy, salpingo-oophorectomy, or oophorectomy, and subsequently had a urinary tract injury.

RESULTS

In a total of 2068 patients, 25 urinary tract injuries occurred (1.21%), including 21 urinary bladder lesions (1.02%) and four ureteral injuries (0.19%). The incidence of urinary tract injuries was 3% in oncologic procedures and 0.86% in procedures for benign disease. Nineteen injuries (76%) were diagnosed intraoperatively, and six injuries (24%) were clinically diagnosed after surgery. All of the patients had uneventful postoperative renal ultrasound examinations.

CONCLUSION

Routine postoperative renal ultrasonography was not capable of diagnosing urinary tract injuries after gynecologic surgery. Routine postoperative renal ultrasound examinations should, therefore, not be performed after gynecologic operations.

Post-Hysterectomy Transient Hydronephrosis: A Prospective Study

Objective: To determine the incidence and importance of transient asymptomatic hydronephrosis following total hysterectomy.

Materials and methods: In a prospective study over 4 year, 368 women were studied who had undergone a total abdominal or vaginal hysterectomy. Totally, 95% of operations were done for benign diseases (abnormal uterine bleeding, chronic pelvic pain, uterine prolapse, etc.) and 5% were performed for uterine malignancy. Renal ultrasonography was performed before and 3, 7 and 28 days after the surgery for diagnosing hydronephrosis. Intravenous urography was performed in patients with either persistent/progressive or symptomatic hydronephrosis.

Results: There was no intraoperative identifiable ureteral injury. Hydronephrosis was seen in 35 (9.5%), 21 (5.7%), and 1 (0.27%) patients at days 3, 7 and 28 after the operation, respectively. The degree of hydronephrosis was graded I, II or III. Considering the frequency and severity of hydronephrosis, the right kidney was affected more. Hydronephrosis correlated significantly with indication, duration and route of surgery as well as patient's age. All kidneys improved spontaneously, except one case which needed ureteral stenting with no surgical intervention (p=0.05).

Conclusion: Transient hydronephrosis could occur after simple total hysterectomy despite the absence of any obvious intraoperative ureteral injury. It is noted in 9.5% of the patients within three days after the non-complicated surgery. The clinical course may be continued until one month.

Is Hydronephrosis a Complication after Anterior Lumbar Surgery?

Study Design Prospective follow-up design. Objective Ureteral injury is a recognized complication following gynecologic surgery and can result in hydronephrosis. Anterior lumbar surgery includes procedures like anterior lumbar interbody fusion (ALIF) and total disk replacement (TDR). Anterior approaches to the spine require mobilization of the great vessels and visceral organs. The vascular supply to the ureter arising from the iliac arteries may be compromised during midline retraction of the ureter, which could theoretically lead to ureter ischemia and stricture with subsequent hydronephrosis formation. Methods Potential candidates with previous ALIF or TDR via anterior retroperitoneal access between January 2008 and March 2012 were chosen from those operated on by a single surgeon in a university hospital setting (n = 85). Renal ultrasound evaluation of hydronephrosis was performed on all participants. Simple descriptive and inferential statistics were used to generate results. Results A total of 37 voluntary participants were recruited (23 male, 14 female subjects; average age 51.8 years). The prevalence of hydronephrosis in our population was 0.0% (95% confidence interval 0 to 8.1%). Conclusions Retraction of the ureter across the midline in ALIF and TDR does not result in an increase in hydronephrosis and appears to be a safe surgical technique.

[Urinary, infectious and digestive adverse events related to benign hysterectomy and the associated surgery on the Fallopian tube: Guidelines]

OBJECTIVES

To provide clinical practice guidelines from the French College of Obstetrics and Gynecology (CNGOF) based on the best evidence available, concerning the urinary, infectious and digestive adverse events related to benign hysterectomy and the associated surgery including opportunistic salpingectomy and adnexectomy.

MATERIAL AND METHOD

Review of literature using following keywords: benign hysterectomy; urinary injury; bladder injury; ureteral injury; vesicovaginal fistula; infection; bowel injury; salpingectomy.

RESULTS

Urinary catheter should be removed before 24h following uncomplicated hysterectomy (grade B). In case of urinary catheter during hysterectomy, immediate postoperative removal is possible (grade C). No hemostasis technics can be recommended to avoid urinary injury (grade C). There is not any evidence to recommend to perform a window in the broad ligament or an ureterolysis, to put ureteral stent or a uterine manipulator in order to avoid ureteral injury. An antibiotic prophylaxis by a cephalosporin is always recommended (grade B). Mechanical bowel preparation before hysterectomy is not recommended (grade B). If there is no ovarian cyst/disease and no familial or personal history of ovarian/breast cancer, ovarian conservation is recommended in premenopausal women (grade B). In postmenopausal women, informed consent and surgical approach should be taken in account to perform a salpingo-oophorectomy. Since the association salpingectomy and hysterectomy is not assessed in the prevention of ovarian cancer, systematic bilateral salpingectomy is not recommended (expert consensus).

CONCLUSIONS

Practical application of these guidelines should decrease the prevalence of visceral complications associated with benign hysterectomy.

Spontaneous urinary extravasation: detection rate with 64-row multidetector computed tomography in patients presenting with acute abdomen

The aim of this study was to detect the rate of spontaneous urinary extravasation (SUE) with computed tomography (CT) in patients presenting with acute abdomen. Seven hundred thirteen abdominal CT examinations with i.v. contrast media requested mainly from the emergency department and urology clinics for sudden onset abdominal pain, flank pain, nonspecific abdominal pain with nausea and vomiting, and renal colic between September 2007 and August 2011 were retrospectively reviewed. Only adult patients were included in the study. Three patients with SUE were detected. One had a mid-ureteral stone while the etiology for the other two patients was unknown. Two of the patients were treated conservatively; one was treated with stenting with a double-j catheter. SUE should be considered in the differential diagnosis of patients presenting with acute abdomen and perinephric-periureteral fluid collection inconsistent with stone size and who are occasionally stone free. Early and precise diagnosis of SUE plays an important role in the management protocol of patients presenting with acute abdomen.