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Martire FG, Giorgi M, Labanca L, Centini G, Catania F, Exacoustos C, Zupi E, Lazzeri L. Unilateral hydroureteronephrosis after introduction of a levonorgestrel-releasing intrauterine system: a case report and literature review. Minerva Obstet Gynecol 2023; 75:491-497. [PMID: 36255159 DOI: 10.23736/s2724-606x.22.05112-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Insertion of a LNG-Intra-uterine System (LNG-IUS) has many gynecological indications. The approved indications worldwide are contraception, treatment of abnormal uterine bleeding depending on not organic disease, and endometrial protection in case of an estrogenic therapy. Instead adenomyosis, fibroids, and fertility-sparing management of endometrial hyperplasia or early endometrial cancer in patients with desire of pregnancy are off label indications. Hydroureteronephrosis is an uncommon complication during LNG-IUS insertion. There are few cases described in the literature. The first diagnostic approach for this complication is an abdominal-pelvic ultrasound scan to identify the abnormal position of the device. Diagnostic management includes computed tomography (CT) or magnetic resonance imaging (MRI), which are necessary to confirm hydroureteronephrosis and to assess the exact location of the LNG-IUS in the abdomen. A minimally invasive approach is the standard of care with the removal of the device, while the therapeutic management of the hydroureteronephrosis depends on ureteral and kidney involvement. We report the history of a dislocated LNG-IUS in the left paracervical space with subsequent ipsilateral hydroureteronephrosis. In our case we removed the device through hysteroscopy and later inserted a J-J stent. Follow-up at three months revealed the persistence of left hydroureteronephrosis, so we performed ureter reimplantation. We also performed a review of the literature to analyze common diagnostic and therapeutic pathways for this rare complication.
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Affiliation(s)
- Francesco G Martire
- Unit of Gynecology, Department of Surgical Sciences, Tor Vergata University, Rome, Italy
- Unit of Gynecology, Department of Surgical Sciences, Valdarno Hospital, Azienda USL Toscana Sud Est, Montevarchi, Arezzo, Italy
| | - Matteo Giorgi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy -
| | - Luca Labanca
- Unit of Gynecology, Department of Surgical Sciences, Valdarno Hospital, Azienda USL Toscana Sud Est, Montevarchi, Arezzo, Italy
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Francesco Catania
- Unit of Gynecology, Department of Surgical Sciences, Valdarno Hospital, Azienda USL Toscana Sud Est, Montevarchi, Arezzo, Italy
| | - Caterina Exacoustos
- Unit of Gynecology, Department of Surgical Sciences, Tor Vergata University, Rome, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
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Application of Indocyanine Green in Combination with Da Vinci Xi Robot in Surgeries on the Upper Urinary Tract: A Case Series Study. J Clin Med 2023; 12:jcm12051980. [PMID: 36902765 PMCID: PMC10004405 DOI: 10.3390/jcm12051980] [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: 12/23/2022] [Revised: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND To explore the application value of intraoperative imaging by indocyanine green (ICG) injection through the collection system of the urinary tract for Da Vinci Xi robot navigation in complex surgeries on the upper urinary tract. METHODS Data of 14 patients who underwent complex surgeries of the upper urinary tract post-ICG injection through the collection system of the urinary tract in combination with Da Vinci Xi robot navigation in the Tianjin First Central Hospital between December 2019 and October 2021 were analyzed in this retrospective study. The operation duration, estimated blood loss, and exposure time of ureteral stricture to ICG were evaluated. The renal functions and tumor relapse were evaluated after surgery. RESULTS Of the fourteen patients, three had distal ureteral stricture, five had ureteropelvic junction obstruction, four presented duplicate kidney and ureter, one had a giant ureter, and one presented an ipsilateral native ureteral tumor after renal transplantation. The surgeries in all patients were successful, with no conversion to open surgery. In addition, no injury to the surrounding organs, anastomotic stenosis or leakage, or ICG injection-related side effects were detected. Imaging at 3 months post-operatively revealed improved renal functions compared to those before the operation. No tumor recurrence or metastasis was observed in patient 14. CONCLUSION Fluorescence imaging compensating for the inadequacy of tactile feedback in the surgical operating system has advantages in identifying the ureter, determining the site of ureteral stricture, and protecting the blood flow for the ureter.
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Patel UJ, Heisler CA. Urinary Tract Injury During Gynecologic Surgery: Prevention, Recognition, and Management. Obstet Gynecol Clin North Am 2021; 48:535-556. [PMID: 34416936 DOI: 10.1016/j.ogc.2021.05.007] [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: 11/30/2022]
Abstract
Lower urinary tract (LUT) injuries may occur during gynecologic surgery due to the close proximity of pelvic organs and vary by procedure, surgical indication, and route. Prevention of LUT injury should be a primary goal of gynecologic surgery. LUT injuries are more common in patients with aberrant anatomy, during difficult procedures, and with surgeons with less experience. Immediate recognition and management of LUT injuries is optimal, although delayed postoperative diagnoses may be unavoidable. Surgical management is based on the size and location of injury and should be performed by an experienced surgeon with thorough knowledge of pelvic anatomy, surgical technique, and postoperative management.
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Affiliation(s)
- Ushma J Patel
- Department of Obstetrics & Gynecology, University of Wisconsin School of Medicine and Public Health, 202 South Park Street, 5E, Madison, WI 53715, USA
| | - Christine A Heisler
- Department of Obstetrics & Gynecology, University of Wisconsin School of Medicine and Public Health, 202 South Park Street, 5E, Madison, WI 53715, USA; Department of Urology, University of Wisconsin School of Medicine and Public Health, 202 South Park Street, 2E, Madison, WI 53715, USA.
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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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Three different laparoscopic techniques for the management of iatrogenic ureteral injury: A multi-institutional study with medium-term outcomes. Asian J Surg 2021; 44:964-968. [PMID: 33608203 DOI: 10.1016/j.asjsur.2021.01.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Excellent success rates with short-term outcomes are noted for laparoscopic ureteral reconstruction (LUR) for iatrogenic ureteral injury. This multi-institutional study assessed the medium-term (>1 year) outcomes and compared three surgical techniques of LUR. METHODS Patients who underwent LUR at five tertiary hospitals between January 2007 and June 2016 were retrospectively analyzed. Patients with active abdominopelvic inflammatory disease, history of urothelial cancer, and tumor recurrence and those who received adjuvant chemotherapy or radiotherapy were excluded. RESULTS The success rates of LUR for 61 patients at 3 months postoperatively and at the last follow-up (at least 12 months postoperatively) were 100% and 95.1%, respectively. No significant difference was noted in the success rates of the three types of LUR. LUR was mainly performed in response to the demands of the primary surgeon responsible for the iatrogenic injury (33 of 45 cases, 73.3%). The vesicoureteral reflux (VUR) incidence was higher in the refluxing laparoscopic ureteroneocystostomy (LUN) group (40%) than in the anti-refluxing LUN group (15%, odds ratio: 1.5, p = 0.252). None of the patients in the LUN groups received treatment for VUR during the follow-up. The laparoscopic end-to-end ureteroureterostomy (LEEU) group had shorter operative time (p < 0.001) and lesser intraoperative blood loss (p < 0.001) than the LUN groups. CONCLUSION LUR is safe and feasible, with good medium-term outcomes. LEEU is a good surgical option in terms of the operative and subsequent outcomes. The anti-reflux technique in LUR reduces de-novo VUR development but is not necessary for preventing upper urinary tract infections in adults.
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Kapogiannis F, Spartalis E, Fasoulakis K, Tsourouflis G, Dimitroulis D, Nikiteas NI. Laparoscopic and Robotic Management of Ureteral Stricture in Adults. In Vivo 2021; 34:965-972. [PMID: 32354881 DOI: 10.21873/invivo.11864] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIM The aim of this review was to provide an update on the status of minimal invasive treatment of ureteral stricture either with a laparoscopic or robotic surgery. MATERIALS AND METHODS Eligible studies, published until November 2019 were retrieved through Medline, Cochrane and Pubmed databases. Predetermined inclusion and exclusion criteria were used as selection method for data synthesis and acquisition. The study was performed in accordance with the PRISMA statement. RESULTS A total of 19 retrospective studies met the inclusion criteria. All of them demonstrated the safety, feasibility and success of both laparoscopic and robotic ureteral reconstruction. Individual case series or cumulative comparison analysis of the available studies showed at least equivalent success rates and a trend favoring laparoscopic and robotic groups in terms of estimated blood loss and length of hospital stay to the detriment of longer operative times and possibly higher cost. CONCLUSION Current evidence suggests the effectiveness, safety and increasing incorporation of minimally invasive techniques for complex stricture repair and reconstruction.
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Affiliation(s)
- Filippos Kapogiannis
- Department of Urology, Hippokrateion Hospital, Athens, Greece .,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Gerasimos Tsourouflis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos I Nikiteas
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Hung ZC, Hsu TH, Jiang LY, Chao WT, Wang PH, Chen WJ, Huang EYH, Chen YJ, Lin ATL. Robot-assisted laparoscopic ureteral reconstruction for ureter endometriosis: Case series and literature review. J Chin Med Assoc 2020; 83:288-294. [PMID: 32080024 DOI: 10.1097/jcma.0000000000000249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of this report was to review experience from a single hospital in treating ureteral obstruction related to endometriosis with robot-assisted laparoscopic ureteral reconstruction. METHODS This retrospective analysis study (Canadian Task Force classification II-3) was conducted at an academic tertiary hospital. Five female patients with hydronephrosis without significant elevation of serum creatinine levels were enrolled. Ureteral endometriosis with obstruction was suspected on radiological images. Previous treatment with double-J stenting with or without medical treatment had failed in all of the patients. We performed robot-assisted laparoscopic segmental resection for ureteral endometriosis and reconstructed the ureter through ureteroureterostomy (RUU) or ureteroneocystostomy (RUC). The involved ureters included left lower ureter in three patients and right lower ureter in two patients. RUU was performed in four patients and RUC in one patient. All of the operations were completed smoothly without complications. RESULTS All ureteral endometrioses were successfully resected, and follow-up sonography or intravenous pyelography showed resolution of hydronephrosis in all of the patients. CONCLUSION Our experience proves the feasibility and efficacy of a robot-assisted approach for this rare situation with good outcomes.
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Affiliation(s)
- Zhi-Chen Hung
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzu-Hsiang Hsu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ling-Yu Jiang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wei-Ting Chao
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wei-Jen Chen
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Eric Yi-Hsiu Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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Ye H, You D, Li L, Cao H, Luo D, Shen H, Chen H, Xi M. Pelvic dimension as a predictor of ureteral injury in gynecological cancer surgeries. Surg Endosc 2019; 34:3920-3926. [PMID: 31595400 DOI: 10.1007/s00464-019-07162-6] [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: 03/02/2019] [Accepted: 09/24/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ureteral injury is an intractable complication in gynecological cancer surgeries. Identifying risk factors can ensure safety of the ureters intraoperatively. A narrow pelvis is known to exert extra difficulties in pelvic surgeries. However, whether pelvic dimension can affect the risk of ureteral injury in gynecological cancer surgeries is poorly understood. We aimed to evaluate the association between pelvic dimension and the risk of ureteral injury during gynecological cancer surgeries. METHODS All patients who had undergone gynecological cancer surgeries were searched from January 2011 to July 2017. We included patients with ureteral injury who had available data of abdominal and pelvic computed tomography for measuring pelvic dimensions. Multivariate condition logistic analysis was used to identify the risk factors independently correlated with ureteral injury in gynecological cancer surgeries. RESULTS A total of 43 cases with 86 controls were included in this study. We discovered that a longer anteroposterior diameter of the mid-pelvis (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.01-1.13, P = 0.019) and a shorter transverse diameter of the mid-pelvis (OR 0.92, 95% CI 0.86-0.98, P = 0.013) were associated with ureteral injury in gynecological cancer surgeries. In laparoscopic analysis, a longer anteroposterior diameter of the mid-pelvis (OR 1.11, 95% CI 1.00-1.24, P = 0.041) was a risk factor for ureteral injury. In the analysis of open surgery, a longer transverse diameter of the mid-pelvis (OR 0.79, 95% CI 0.66-0.93, P = 0.006) was a protective factor for ureteral injury. CONCLUSIONS This study demonstrated that mid-pelvis dimensions were associated with ureteral injury, but the observed differences were too small. In addition, pelvic inlet dimensions did not appear to relate with ureteral injury. Thus, these pelvimetry measures could not be beneficial in assessing the risk of ureteral injury in gynecological cancer surgeries.
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Affiliation(s)
- Hui Ye
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Number 20, Third Section of People's South Road, Chengdu, 610000, China
| | - Di You
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Number 20, Third Section of People's South Road, Chengdu, 610000, China
| | - Lin Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Number 20, Third Section of People's South Road, Chengdu, 610000, China
| | - Hanyu Cao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Number 20, Third Section of People's South Road, Chengdu, 610000, China
| | - Deyi Luo
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Shen
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Huizhu Chen
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Mingrong Xi
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Number 20, Third Section of People's South Road, Chengdu, 610000, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
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Sun G, Yan L, Ouyang W, Zhang Y, Ding B, Liu Z, Yu X, Hu Z, Li H, Wang S, Ye Z. Management for Ureteral Stenosis: A Comparison of Robot-Assisted Laparoscopic Ureteroureterostomy and Conventional Laparoscopic Ureteroureterostomy. J Laparoendosc Adv Surg Tech A 2019; 29:1111-1115. [PMID: 31314664 DOI: 10.1089/lap.2019.0357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: To describe and analyze our experience of robotic-assisted laparoscopic ureteroureterostomy (RALU) and conventional LU for the repair of ureteral stenosis and compare the differences of safety and efficacy between RALU and LU. Materials and Methods: Patients who underwent RALU or LU for ureteral stenosis were retrospectively analyzed. Baseline characteristics, details of stenosis, surgery and some laboratory tests, and follow-up data were collected and analyzed. Results: Among 126 patients presented with ureteral stenosis, 65 patients underwent RALU and 61 patients underwent LU. All operations were completed successfully without conversion to open surgery. Both groups were comparable in baseline characteristics and details of stenosis. The mean operative time, suturing time, and hospitalization time of patients in RALU group were significantly less than those in LU group. The mean operative time of the RALU group was 126.34 minutes, whereas the mean operative time of the LU group was 176.57 minutes (P < .001). The average suturing time of RALU and LU was 26.88 and 70.43 minutes, respectively (P < .001). The mean hospitalization time of RALU and LU was 4.01 and 5.02, respectively (P < .001). RALU presented a lower degree of leukocytes rise than LU (P < .001). The mean follow-up time was 29.52 months. Conclusions: RALU and LU both are safe and feasible for ureteral stenosis with a low incidence of complications. Compared with LU, RALU may be a better choice with shorter operative time, suturing time, postoperative hospitalization time, and slighter inflammation. Further clinical studies of high quality are needed to confirm the priority of RALU.
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Affiliation(s)
- Guoliang Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Libin Yan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Ouyang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Beichen Ding
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Yu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Gild P, Kluth LA, Vetterlein MW, Engel O, Chun FKH, Fisch M. Adult iatrogenic ureteral injury and stricture-incidence and treatment strategies. Asian J Urol 2018; 5:101-106. [PMID: 29736372 PMCID: PMC5934506 DOI: 10.1016/j.ajur.2018.02.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 05/22/2017] [Accepted: 06/23/2017] [Indexed: 11/03/2022] Open
Abstract
Iatrogenic ureteral injuries and strictures are relatively common complication of pelvic surgery and radiation treatment. Left untreated they are associated with severe short- and long-term complications such as urinoma, septic state, renal failure, and loss of a renal unit. Treatment depends on timing of diagnosis, as well as extent of injury, and ranges from simple endoscopic management to complex surgical reconstruction under usage of pedicled grafts. While recent advances in ureteral tissue engineering are promising the topic is still underreported. Historically a domain of open surgery, laparoscopic and robotic-assisted approaches have proven their feasibility in small case series, and are increasingly being utilized as means of reconstructive surgery. This review aims to give an outline of incidence and treatment of ureteral injuries and strictures in light of the latest advances.
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Affiliation(s)
- Philipp Gild
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Luis A Kluth
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Engel
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K H Chun
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Prevention, Recognition, and Management of Urologic Injuries During Gynecologic Surgery. Obstet Gynecol 2017; 127:1085-1096. [PMID: 27159741 DOI: 10.1097/aog.0000000000001425] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The urethra, bladder, and ureters are particularly susceptible to injury during gynecologic surgery. When preventive measures fail, prompt recognition and management of injury can avoid long-term sequelae such as fistula formation and loss of renal function. Intraoperative identification should be the primary goal when an injury occurs, although this is not always possible. Postoperative injury recognition requires a high level of suspicion and vigilance. In addition to history and physical examination, appropriate radiologic studies can be useful in localizing injury and planning management strategies. Some injuries may require Foley catheter drainage or ureteral stenting alone, whereas others will require operative intervention with ureteral resection and reanastomosis or reimplantation. Prompt restoration of urinary drainage or diversion will avoid further renal compromise.
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12
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Robotic "Side Hole" Technique Placement of Ureteral Stent for Ureteral Lesion. Urol Case Rep 2017; 13:77-78. [PMID: 28462162 PMCID: PMC5408132 DOI: 10.1016/j.eucr.2016.08.007] [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: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 11/12/2022] Open
Abstract
A 67-year-old patient underwent robotic-assisted laparoscopic radical prostatectomy and experienced right ureteral lesion. The laceration was recognized intraoperatively and immediately repaired over the ureteral double J stent. The wire and the stent were first advanced distally to the bladder. Then the wire was pulled with its soft end, cranially through one of the side holes of the proximal end of the stent toward the kidney allowing exact positioning of the stent. Postoperative hospitalization was similar to a classic laparoscopic robotic-assisted prostatectomy. Robotic approach and the “side hole” technique represent an accurate and safe option in case of ureteral laceration management.
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Abu-Zaid A, Abou Al-Shaar H, Azzam A, AlOmar O, Al-Otaibi MF, Amin T, Al-Badawi IA. Routine ureteric stenting before cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in managing peritoneal carcinomatosis from gynecologic malignancies: a single-center experience. Ir J Med Sci 2017; 186:269-273. [PMID: 27052968 DOI: 10.1007/s11845-016-1452-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 03/21/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Iatrogenic ureteric injury is a rare, yet serious operative complication in gynecologic procedures and associated with substantial morbidities such as prolonged hospitalization, additional financial-based ureter-related repairing procedures, impaired renal function, and compromised quality of life. Direct visual identification of ureters can be very challenging in managing patients with primary advanced or recurrent disseminated intraperitoneal gynecologic malignancies, who are referred to complex procedures such as cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). AIMS To report our single-center experience (feasibility and morbidity) with prophylactic ureteric stents as a routine practice before CRS+HIPEC procedure in managing peritoneal carcinomatosis (PC) from gynecologic malignancies. METHODS From June-2010 to March-2014, all patients with gynecologic-related PC, managed with CRS+HIPEC, and underwent prophylactic ureteric stents. The data were retrospectively abstracted and analyzed. RESULTS Fifty-three patients were identified. Almost all PC cases were secondary/recurrence presentations (90.6 %) and originated from ovarian cancer (84.9 %). Optimal cytoreduction microscopic residual disease) was achieved in 35 patients (60 %). Average insertion time of ureteric stents was 8.9 ± 3.3 min. Fifty-two patients (98.1 %) received bilateral ureteric stents. Forty-nine patients (92.5 %) had their ureteric stents removed by the end of procedure. No patient experienced major peri-operative urinary tract-related complications. CONCLUSIONS Prophylactic ureteric stents appeared to be feasible, potentially safe, and could reduce the risk of iatrogenic ureteric injuries without incurring an increase in urinary tract-related complications. Prophylactic ureteric stenting does not eliminate the necessity for competent anatomical knowledge, meticulous retroperitoneal dissection and direct intra-operative visualization of ureters.
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Affiliation(s)
- A Abu-Zaid
- Department of Obstetrics and Gynecology, MBC-52, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh, 11211, Saudi Arabia
- King Faisal Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - H Abou Al-Shaar
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - A Azzam
- King Faisal Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - O AlOmar
- Department of Obstetrics and Gynecology, MBC-52, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh, 11211, Saudi Arabia
| | - M F Al-Otaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - T Amin
- King Faisal Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - I A Al-Badawi
- Department of Obstetrics and Gynecology, MBC-52, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh, 11211, Saudi Arabia.
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
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Schiavina R, Zaramella S, Chessa F, Pultrone CV, Borghesi M, Minervini A, Cocci A, Chindemi A, Antonelli A, Simeone C, Pagliarulo V, Parma P, Samuelli A, Celia A, De Concilio B, Rocco B, De Lorenzis E, La Manna G, Terrone C, Falsaperla M, Dente D, Porreca A. Laparoscopic and robotic ureteral stenosis repair: a multi-institutional experience with a long-term follow-up. J Robot Surg 2016; 10:323-330. [PMID: 27209477 DOI: 10.1007/s11701-016-0601-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/26/2016] [Indexed: 11/30/2022]
Abstract
The treatment of ureteral strictures represents a challenge due to the variability of aetiology, site and extension of the stricture; it ranges from an end-to-end anastomosis or reimplantation into the bladder with a Boari flap or Psoas Hitch. Traditionally, these procedures have been done using an open access, but minimally invasive approaches have gained acceptance. The aim of this study is to evaluate the safety and feasibility and perioperative results of minimally invasive surgery for the treatment of ureteral stenosis with a long-term follow-up. Data of 62 laparoscopic (n = 36) and robotic (n = 26) treatments for ureteral stenosis in 9 Italian centers were reviewed. Patients were followed according to the referring center's protocol. Laparoscopic and robotic approaches were compared. All the procedures were completed successfully without open conversion. Average estimated blood loss in the two groups was 91.2 ± 71.9 cc for the laparoscopic and 47.2 ± 32.3 cc for the robotic, respectively (p = 0.004). Mean days of hospitalization were 5.9 ± 2.4 for the laparoscopic group and 7.6 ± 3.4 for the robotic group (p = 0.006). No differences were found in terms of operative time and post-operative complications. After a median follow-up of 27 months, the robotic group yielded 2 stenosis recurrence, instead the laparoscopic group shows no cases of recurrence (p = 0.091). Minimally invasive approach for ureteral stenosis is safe and feasible. Both robotic and pure laparoscopic approaches may offer good results in terms of perioperative outcomes, low incidence of complications and recurrence.
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Affiliation(s)
- Riccardo Schiavina
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Palagi 9 Street, 40134, Bologna, Italy
| | - Stefano Zaramella
- Department Of Urology, University of Eastern Piedmont Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy
| | - Francesco Chessa
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Palagi 9 Street, 40134, Bologna, Italy.
| | - Cristian Vincenzo Pultrone
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Palagi 9 Street, 40134, Bologna, Italy
| | - Marco Borghesi
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Palagi 9 Street, 40134, Bologna, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Chindemi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Claudio Simeone
- Department of Urology, University of Brescia, Brescia, Italy
| | | | - Paolo Parma
- Department of Urology, Ospedale "Carlo Poma" Mantova, Mantova, Italy
| | | | - Antonio Celia
- Dept. Of Urology, Ospedale "San Bassiano", Bassano del Grappa, VI, Italy
| | | | - Bernardo Rocco
- Department of Urology, Policlinico Di Milano, Milan, Italy
| | | | - Gaetano La Manna
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Carlo Terrone
- Department Of Urology, University of Eastern Piedmont Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy
| | - Mario Falsaperla
- Department of Urology, Policlinico Vittorio Emanuele, Catania, Italy
| | - Donato Dente
- Department of Urology, Policlinico Di Abano, Abano Terme, PD, Italy
| | - Angelo Porreca
- Department of Urology, Policlinico Di Abano, Abano Terme, PD, Italy
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Esparaz AM, Pearl JA, Herts BR, LeBlanc J, Kapoor B. Iatrogenic urinary tract injuries: etiology, diagnosis, and management. Semin Intervent Radiol 2015; 32:195-208. [PMID: 26038626 PMCID: PMC4447880 DOI: 10.1055/s-0035-1549378] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Iatrogenic injury to the urinary tract, including the kidneys, ureters, bladder, and urethra, is a potential complication of surgical procedures performed in or around the retroperitoneal abdominal space or pelvis. While both diagnostic and interventional radiologists often play a central and decisive role in the identification and initial management of a variety of iatrogenic injuries, discussions of these injuries are often directed toward specialists such as urologists, obstetricians, gynecologists, and general surgeons whose procedures are most often implicated in iatrogenic urinary tract injuries. Interventional radiologic procedures can also be a source of an iatrogenic urinary tract injury. This review describes the clinical presentation, risk factors, imaging findings, and management of iatrogenic renal vascular and urinary tract injuries, as well as the radiologist's role in the diagnosis, treatment, and cause of these injuries.
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Affiliation(s)
- Anthony M. Esparaz
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Brian R. Herts
- Department of Abdominal Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justin LeBlanc
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Baljendra Kapoor
- Department of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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17
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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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Bañuelos B, Aguilera A, López D, de la Peña-Barthel JJ. Lesiones genitourinarias en cirugía ginecológica y general. Una revisión de 3 años. Rev Int Androl 2015. [DOI: 10.1016/j.androl.2014.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tyritzis SI, Wiklund NP. Ureteral strictures revisited…trying to see the light at the end of the tunnel: a comprehensive review. J Endourol 2014; 29:124-36. [PMID: 25100183 DOI: 10.1089/end.2014.0522] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A ureteral stricture is a rather rare urological event defined as a narrowing of the ureter causing a functional obstruction and renal failure, if left untreated. The aim of this review article is to summarize and discuss current knowledge on the incidence, pathogenesis, management, and follow up of proximal, mid, and distal ureteral strictures.
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Affiliation(s)
- Stavros I Tyritzis
- 1 Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm, Sweden
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Juarez-Soto A, Arroyo-Maestre JM, Soto-Delgado M, Beardo-Villar P, Arrabal-Polo MA, Sánchez-Margallo FM. Laparoscopic dissection of the intramural ureter to repair a complete transection of the distal ureter: Initial experience with a new minimally invasive technique that preserves the anatomy of the urinary tract. Can Urol Assoc J 2014; 8:E366-70. [PMID: 24940468 DOI: 10.5489/cuaj.1699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report 2 patients with ureteral injury after a simple total laparoscopic hysterectomy for uterine myoma with a complete resection of the distal ureter. One patient had unilateral injury and the other 2 patients had bilateral injury. The surgical laparoscopic repair procedure was carried out 3 to 5 days after the injury. Surgery involved intramural dissection of the distal ureteral stump to expose at least 1 cm of the ureter, percutaneous ureteral stent placement, elimination of tension between the proximal ureter and the dissected distal stump, end-to-end anastomosis, and reinsertion of the distal ureter into the bladder muscle layer, which was previously dissected for the anastomosis.
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Pietersma CS, Schreuder HWR, Kooistra A, Koops SES. Robotic-assisted laparoscopic repair of a vesicovaginal fistula: a time-consuming novelty or an effective tool? BMJ Case Rep 2014; 2014:bcr-2014-204119. [PMID: 24916979 DOI: 10.1136/bcr-2014-204119] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vesicovaginal fistulas are a rare complication of hysterectomy. When conservative therapy fails, vaginal or abdominal repair is necessary. A robotic-assisted laparoscopic approach can be a useful tool to repair complex fistulas. A 50-year-old woman with a vesicovaginal fistula located at the top of the vagina, was treated with robotic-assisted laparoscopic repair. The fistula tissue was removed from the vaginal wall and bladder, and epiploic of the sigmoid was interposed in between. The total operation time was 104 min. The hospital stay was 3 days; no complications occurred. Cystography 6 weeks and 6 months postoperative confirmed a successful repair. A review of current literature is presented regarding the application of robotic assistance during this procedure. The presented case shows that robotic-assisted laparoscopic repair of a vesicovaginal fistula seems to be a feasible technique with promising results.
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Affiliation(s)
- Carsten S Pietersma
- Division of Women and Baby, Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Henk W R Schreuder
- Division of Women and Baby, Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anko Kooistra
- Department of Urology, Meander Medical Centre, Amersfoort, The Netherlands
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Komninos C, Koo KC, Rha KH. Laparoendoscopic management of midureteral strictures. Korean J Urol 2014; 55:2-8. [PMID: 24466390 PMCID: PMC3897625 DOI: 10.4111/kju.2014.55.1.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 01/08/2014] [Indexed: 11/18/2022] Open
Abstract
The incidence of ureteral strictures has increased worldwide owing to the widespread use of laparoscopic and endourologic procedures. Midureteral strictures can be managed by either an endoscopic approach or surgical reconstruction, including open or minimally invasive (laparoscopic/robotic) techniques. Minimally invasive surgical ureteral reconstruction is gaining in popularity in the management of midureteral strictures. However, only a few studies have been published so far regarding the safety and efficacy of laparoscopic and robotic ureteral reconstruction procedures. Nevertheless, most of the studies have reported at least equivalent outcomes with the open approach. In general, strictures more than 2 cm, injury strictures, and strictures associated either with radiation or with reduced renal function of less than 25% may be managed more appropriately by minimally invasive surgical reconstruction, although the evidence to establish these recommendations is not yet adequate. Defects of 2 to 3 cm in length may be treated with laparoscopic or robot-assisted uretero-ureterostomy, whereas defects of 12 to 15 cm may be managed either via ureteral reimplantation with a Boari flap or via transuretero-ureterostomy in case of low bladder capacity. Cases with more extended defects can be reconstructed with the incorporation of the ileum in ureteral repair.
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Affiliation(s)
- Christos Komninos
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. ; Department of Urology, General Hospital of Nikaia 'St. Panteleimon', Athens, Greece
| | - Kyo Chul Koo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Minas V, Gul N, Aust T, Doyle M, Rowlands D. Urinary tract injuries in laparoscopic gynaecological surgery; prevention, recognition and management. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/tog.12073] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Vasileios Minas
- ST7 Obstetrics and Gynaecology; Minimal Access Centre; Department of Obstetrics & Gynaecology; Wirral University Teaching Hospital; Arrowe Park Road Wirral Merseyside CH49 5PE UK
| | - Nahid Gul
- Minimal Access Centre; Department of Obstetrics & Gynaecology; Wirral University Teaching Hospital; Arrowe Park Road Wirral Merseyside CH49 5PE UK
| | - Thomas Aust
- Minimal Access Centre; Department of Obstetrics & Gynaecology; Wirral University Teaching Hospital; Arrowe Park Road Wirral Merseyside CH49 5PE UK
| | - Mark Doyle
- Minimal Access Centre; Department of Obstetrics & Gynaecology; Wirral University Teaching Hospital; Arrowe Park Road Wirral Merseyside CH49 5PE UK
| | - David Rowlands
- Minimal Access Centre; Department of Obstetrics & Gynaecology; Wirral University Teaching Hospital; Arrowe Park Road Wirral Merseyside CH49 5PE UK
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Lee Z, Simhan J, Parker DC, Reilly C, Llukani E, Lee DI, Mydlo JH, Eun DD. Novel use of indocyanine green for intraoperative, real-time localization of ureteral stenosis during robot-assisted ureteroureterostomy. Urology 2013; 82:729-33. [PMID: 23987169 DOI: 10.1016/j.urology.2013.05.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 05/25/2013] [Accepted: 05/30/2013] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To present a novel method to intraoperatively localize ureteral strictures during robot-assisted ureteroureterostomy via indocyanine green (ICG) visualization under near-infrared (NIR) light. MATERIALS AND METHODS Seven patients underwent robot-assisted ureteroureterostomy for ureteral stricture by a single surgeon (D.D.E.). Intraoperative localization of ureteral stricture involved instilling ICG (25 mg in 10 mL distilled water) above and below the level of stenosis through a ureteral catheter or a percutaneous nephrostomy tube, or both. The fluorescent tracer was detected as a green color using the NIR modality on the da Vinci Si (Intuitive Surgical, Sunnyvale, CA). All patients consented to off-label use of ICG after full disclosure. RESULTS Intraoperative ICG injection and visualization under NIR light assisted in the performance of a tension-free anastomosis in all patients. At the time of surgery, mean age was 55.7 ± 12.4 years and mean body mass index was 30.3 ± 5.8 kg/m(2). Mean operative time was 171.3 ± 52.4 minutes, mean estimated blood loss was 175.0 ± 146.5 mL, and mean length of ureteral excision on pathologic analysis was 1.6 ± 0.7 cm. There were no immediate or delayed adverse effects attributable to intraureteral ICG administration. Mean hospital length of stay was 1.6 ± 1.5 days, with no postoperative complications. Mean follow-up was 5.9 ± 1.5 months, and all cases were clinically and radiographically successful at last follow-up. CONCLUSION Intraureteral injection of ICG with visualization under NIR light allows for real-time delineation of the ureter. Additionally, ICG administration aids in discerning healthy ureter from diseased tissue, further assisting successful robotic ureteral repair.
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Affiliation(s)
- Ziho Lee
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
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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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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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Affiliation(s)
- Michael Baggish
- The Women's Center, Saint Helena Hospital, Saint Helena, CA
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH (emeritus)
- Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, CA
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Angioli R, Terranova C, Plotti F, Montera R, Damiani P, Scaletta G, Portuesi A, Bonanni A, Tombolini L, Novelli L. Real-time infrared thermography for ureter detection during hysterectomy. J Surg Res 2012; 178:539-44. [PMID: 22835947 DOI: 10.1016/j.jss.2012.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 06/27/2012] [Accepted: 07/03/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Recognition of different anatomic structures might be difficult in the presence of diseases such as neoplasm or endometriosis that can subvert the anatomy. This can be a challenge for young surgeons approaching gynecologic surgery. The aim of the present study was to evaluate the effectiveness of infrared thermocamera to identify the anatomic structures in gynecologic surgery. MATERIALS AND METHODS From February 2010 to May 2011, consecutive patients who required abdominal hysterectomy were considered for eligibility. During a procedure for benign disease, we evaluated the temperature difference between the ureter and infundibulopelvic vessel (experiment A). In patients with gynecologic cancer, the thermal gradient was determined between the iliac vessels and the ureter (experiment B). RESULTS The data from 21 patients were recorded, 12 for experiment A and 9 for experiment B. We found a statistically significant difference between the ureter and vessels in both experiments (31.675°C ± 0.673°C for the ureter and 33.332°C ± 0.828°C for the infundibulopelvic vessel, P < 0.0001; 31.706°C ± 0.751°C for the ureter, 33.787°C ± 0.63°C for the iliac vein, and 33.784°C ± 0.639°C for the iliac artery, P < 0.0001). CONCLUSIONS Infrared imaging allowed us to identify the anatomic structures in laparotomy, providing preliminary data for its application in laparoscopy.
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Affiliation(s)
- Roberto Angioli
- Department of Obstetrics and Gynaecology, Campus Bio Medico, University of Rome, Rome, Italy.
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Kratz KG, Spytek SH, Caceres A, Lukman R, McCarus SD. A randomized, single-blinded pilot study evaluating use of a laparoscope or a cystoscope for cystoscopy during gynecologic surgery. J Minim Invasive Gynecol 2012; 19:606-14. [PMID: 22818539 DOI: 10.1016/j.jmig.2012.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/02/2012] [Accepted: 06/07/2012] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVE To prospectively evaluate time required to perform cystoscopy with a laparoscope or a cystoscope after laparoscopic hysterectomy. Urinary tract symptoms, infection, adverse events, and expense were also evaluated. DESIGN Randomized, single-blind pilot study (Canadian Task Force classification I). SETTING Suburban private gynecology group practice and local community hospital. SUBJECTS Sixty-six subjects scheduled to undergo laparoscopic hysterectomy between January and July 2009. INTERVENTION Either cystoscopy with a laparoscope or a cystoscope. MEASUREMENTS AND MAIN RESULTS Subjects were randomized to undergo either form of cystoscopy, and events were reported. Each subject completed self-reported urinary tract symptom questionnaires before surgery and at 2 weeks after surgery. Clean-catch urine samples were obtained before surgery and postoperatively at day 1 and 2 weeks. In the group who underwent laparoscope cystoscopy, a suction-irrigator device, a 5-mm needle-nose suction irrigator tip, and a 5-mm 0-degree video laparoscope were required. In the group who underwent traditional cystoscopy, a 70-degree video telescope with a 17F sleeve, irrigation fluid, and a light source were required. Subjects were followed up for 6 weeks postoperatively. Adverse events were minimal, with 1 in the laparoscope group and 6 in the traditional cystoscope group. Two postoperative urinary tract infections occurred in the traditional cystoscopy group. The mean total procedural time for laparoscope cystoscopy of 137 seconds was statistically less (p < .001) compared with the 296 seconds in the traditional cystoscopy group. Improvements in urinary tract symptom scores improved from baseline, but were not statistically significantly different between the groups. Traditional cystoscopy equipment cost approximately $60 more per subject. CONCLUSION The study results suggest that laparoscope cystoscopy is more time-efficient and cost-effective than traditional cystoscopy and that the incidence of urinary tract symptoms, infection, and injury did not increase.
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Affiliation(s)
- Katherine G Kratz
- Department of Obstetrics and Gynecology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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30
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Han CM, Tan HH, Kay N, Wang CJ, Su H, Yen CF, Lee CL. Outcome of Laparoscopic Repair of Ureteral Injury: Follow-up of Twelve Cases. J Minim Invasive Gynecol 2012; 19:68-75. [DOI: 10.1016/j.jmig.2011.09.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 09/15/2011] [Accepted: 09/21/2011] [Indexed: 10/15/2022]
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31
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Bouya P, Odzébé A, Otiobanda F, Itoua C, Mahoungou-Guimbi K, Banga M, Andzin M, Ondongo-Atipo M, Ondzel S, Avala P. Les complications urologiques de la chirurgie gynécologique. Prog Urol 2011; 21:875-8. [DOI: 10.1016/j.purol.2011.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 03/27/2011] [Accepted: 03/30/2011] [Indexed: 11/27/2022]
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Janssen P, Brölmann H, Huirne J. Recommendations to Prevent Urinary Tract Injuries During Laparoscopic Hysterectomy: A Systematic Delphi Procedure Among Experts. J Minim Invasive Gynecol 2011; 18:314-21. [DOI: 10.1016/j.jmig.2011.01.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 01/10/2011] [Accepted: 01/13/2011] [Indexed: 10/18/2022]
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Abstract
PURPOSE OF REVIEW To help surgeons and to make patients become fully aware of the risks of laparoscopic surgery. As complications are an inevitable reality of surgery, we need to be aware of the types of complications in a systematic way, train to respond in an appropriate way, and learn to communicate in a transparent and honest way to deal with complications in laparoscopic surgery. RECENT FINDINGS This article aims to classify complications associated with laparoscopy according to the different phases in surgery and to promote a comprehensive strategy for dealing with them. SUMMARY To promote a culture of risk management which delivers the benefits and minimizes the risks associated with laparoscopic surgery.
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Baggish MS. Urinary Tract Injuries Secondary to Gynecologic Laparoscopic Surgery: Analysis of 75 Cases. J Gynecol Surg 2010. [DOI: 10.1089/gyn.2010.0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael S. Baggish
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, and University of Cincinnati, College of Medicine, Cincinnati, OH
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Camanni M, Bonino L, Delpiano EM, Berchialla P, Migliaretti G, Revelli A, Deltetto F. Laparoscopic conservative management of ureteral endometriosis: a survey of eighty patients submitted to ureterolysis. Reprod Biol Endocrinol 2009; 7:109. [PMID: 19818156 PMCID: PMC2770480 DOI: 10.1186/1477-7827-7-109] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Accepted: 10/12/2009] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND this study aims to evaluate the effectiveness and safety of laparoscopic conservative management of ureteral endometriosis. METHODS Eighty cases of histologically confirmed endometriosis affecting the ureter, 10 of which with bladder involvement were prospectively studied. In detail, patients were 13 women with ureteral stenosis (7 with hydronephrosis), 32 with circular lesions totally encasing the ureter, and 35 with endometriotic foci on the ureteral wall, but not completely encasing it. They were submitted to laparoscopic ureterolysis with or without partial cystectomy, ureteroneocistostomy. The rate of surgical complications, the recurrence rate, the patients' satisfaction rate was assessed during 22 months (median) follow-up. RESULTS Laparoscopic ureterolysis was employed for all patients and set free the ureter from the disease in 95% of cases, whereas ureteroneocystostomy was necessary for 4 patients showing severe stenosis with hydronephrosis, among which 2 had intrinsic endometriosis of the ureteral muscularis. Three post-surgery ureteral fistulae occurred in cases with ureteral involvement longer than 4 cm: two cases were successfully treated placing double J catheter, the third needed ureteroneocistostomy. During follow-up, ureteral endometriosis recurred in 2 patients who consequently underwent ureteroneocystostomy. Most patients expressed high satisfaction rate throughout the whole follow-up period. CONCLUSION laparoscopic ureterolysis is effective and well tolerated in most cases of ureteral endometriosis. Ureteroneocystostomy is a better strategy for patients with extended (more than 4 cm) ureteral involvement or with severe stenosis with or without hydronephrosis.
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Affiliation(s)
- Marco Camanni
- GINTEAM Unit of Minimally Invasive Gynaecology, Corso Marconi 35, 10125 Turin, Italy
| | - Luca Bonino
- GINTEAM Unit of Minimally Invasive Gynaecology, Corso Marconi 35, 10125 Turin, Italy
| | - Elena Maria Delpiano
- GINTEAM Unit of Minimally Invasive Gynaecology, Corso Marconi 35, 10125 Turin, Italy
| | - Paola Berchialla
- Department of Public Health and Microbiology, University of Turin, Via Santena 5bis, 10126 Turin, Italy
| | - Giuseppe Migliaretti
- Department of Public Health and Microbiology, University of Turin, Via Santena 5bis, 10126 Turin, Italy
| | - Alberto Revelli
- Reproductive Medicine and IVF Unit, Department of Obstetrical and Gynecological Sciences, Via Ventimiglia 3, 10126 Turin, Italy
| | - Francesco Deltetto
- GINTEAM Unit of Minimally Invasive Gynaecology, Corso Marconi 35, 10125 Turin, Italy
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Lam A, Kaufman Y, Khong SY, Liew A, Ford S, Condous G. Dealing with complications in laparoscopy. Best Pract Res Clin Obstet Gynaecol 2009; 23:631-46. [PMID: 19539536 DOI: 10.1016/j.bpobgyn.2009.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 03/16/2009] [Indexed: 11/26/2022]
Abstract
With increasing adoption of laparoscopic surgery in gynaecology, there has been a corresponding rise in the types and rates of complications reported. This article sets out to classify complications associated with laparoscopy according to the phases of the surgery; assess the incidence, the mechanisms, the presentations; and recommend methods for preventing and dealing with complications in laparoscopic surgery. Its aim is to promote a culture of risk management based on the development of strategies to improve patient safety and outcome.
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Affiliation(s)
- Alan Lam
- Centre for Advanced Reproductive Endosurgery, (CARE), Royal North Shore Hospital, University of Sydney, Sydney, Australia.
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Schonman R, De Cicco C, Corona R, Soriano D, Koninckx PR. Accident analysis: factors contributing to a ureteric injury during deep endometriosis surgery. BJOG 2008; 115:1611-5; discussion 1615. [DOI: 10.1111/j.1471-0528.2008.01941.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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De Cicco C, Schonman R, Craessaerts M, Van Cleynenbreugel B, Ussia A, Koninckx PR. Laparoscopic management of ureteral lesions in gynecology. Fertil Steril 2008; 92:1424-1427. [PMID: 18930224 DOI: 10.1016/j.fertnstert.2008.08.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Revised: 07/21/2008] [Accepted: 08/07/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the outcome of laparoscopic repair of ureteral injury in laparoscopic gynecologic surgery. DESIGN Prospective trial. SETTING University hospital. PATIENT(S) Forty patients with a ureteral lesion in laparoscopic surgery between 1991 and 2007. INTERVENTION(S) Laparoscopic ureteral repair, laparoscopic-assisted or blind stent insertion. MAIN OUTCOME MEASURE(S) Treatment outcome of ureteral lesion analyzed by type of injury, time of diagnosis, and management. RESULT(S) In 4,350 consecutive laparoscopic gynecologic interventions, 42 lesions occurred, 5 during hysterectomy, 1 during adnexectomy, and 36 during deep endometriosis surgery. In the latter group (n = 1,427), the incidence was 1.5% and 21% in women without and with hydronephrosis, respectively. In eight women in whom a stent was inserted after surgery without laparoscopic guidance, five were uneventful and three needed a second intervention. In all 34 women in whom a laparoscopic repair over a stent was performed, the outcome was uneventful, whether diagnosed and treated during surgery (n = 25) or after surgery (n = 9). CONCLUSION(S) Laparoscopic repair over a stent was uneventful for all lacerations, transections, and fistulas, whether performed during or after surgery, and was superior to blind stent insertion. In women with hydronephrosis and deep endometriosis, a preoperative stent insertion seems to be mandatory.
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Affiliation(s)
- Carlo De Cicco
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospital A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Ron Schonman
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marleen Craessaerts
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ben Van Cleynenbreugel
- Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Anastasia Ussia
- Department of Obstetrics and Gynecology, Villa Giose, Crotone, Italy
| | - Philippe Robert Koninckx
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospital A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
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Koninckx PR. Videoregistration of Surgery Should be Used as a Quality Control. J Minim Invasive Gynecol 2008; 15:248-53. [DOI: 10.1016/j.jmig.2007.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 09/15/2007] [Accepted: 12/04/2007] [Indexed: 11/29/2022]
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