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Georgiades F, Kouriefs C, Makanjuola J, Grange P. Trans-urethral bladder suture in female patients: Not a tour de force but a quick and realistic answer to complex situations. Urologia 2021; 89:231-234. [PMID: 33724089 PMCID: PMC9047103 DOI: 10.1177/03915603211001168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Trans-urethral bladder surgery has gained popularity in the fields of electro-resection and laser lithotripsy, with endoscopic suturing being overlooked. Bladder defect closure using a pure trans-urethral suturing technique can provide a quick and effective solution in situations where conventional management options are not feasible. METHODS Here we describe this innovative novel technique developed by our group that was used to treat two different cases with bladder perforation at two different institutions. We used a 5 mm laparoscopic port with gas insufflation and a laparoscopic needle holder trans-urethrally to achieve defect closure with a monofilament 2/0 monocryl mattress suture on a small 22 mm needle. RESULTS The defects were successfully closed without any intraoperative complications. Average operative time for the technique was 18 min with minimal blood loss. Bladder closure was sustained at a median follow-up of 2 years for one of these cases. CONCLUSIONS We claim that transurethral bladder suturing is quick, safe in expert hands and provides an effective option where the clinical condition/situation of the patient warrants a minimally invasive surgery approach.
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Affiliation(s)
- Fanourios Georgiades
- Urology Department, Ygia Polyclinic Hospital, Limassol, Cyprus.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Chryssanthos Kouriefs
- Urology Department, Ygia Polyclinic Hospital, Limassol, Cyprus.,St George's, University of London at the University of Nicosia, Nicosia, Cyprus
| | | | - Philippe Grange
- Urology Department, Kings College Hospital NHS Foundation Trust, London, UK
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Przudzik M, Borowik M, Łesiów M, Łesiów R. Transvesical laparoendosopic single-site surgery as a valuable option to remove eroded materials from the bladder: single-center experience and a review of the literature. Int Urol Nephrol 2018; 51:247-252. [PMID: 30478813 PMCID: PMC6394444 DOI: 10.1007/s11255-018-2039-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Abstract
Introduction Currently, polypropylene materials are used widely for the treatment of various urogynecologic disorders. This type of treatment can be complicated, although rarely, with erosions of the polypropylene implants into the bladder or the urethra. There is no established treatment for such complications. We present our experience in transvesical laparoendoscopic single-site surgery (T-LESS) removal of eroded materials, and a review of the literature in this field. Materials and methods From June 2015 to May 2017 eight females, with an average age of 66.5 years (range 55–80 years), were referred to our Center because of the erosion of polypropylene material in the bladder, after anti-incontinence or pelvic organ prolapse treatment. Patients were diagnosed with ultrasound and cystoscopy. Seven bladder erosions and one bladder and urethral penetration were found. Patients were qualified for removal with the T-LESS approach. The Tri-Port + disposable set and standard laparoscopic instruments were used. The eroded materials were dissected and cut away, and the defects of the bladder wall were closed with barbed sutures. The peri-operative efficacy and safety of the method were assessed, and the patients were scheduled for follow-up visits at 6 weeks and every 3 months thereafter. The patients were offered a cystoscopic exam during the 7–10 month period after the operation. Results The procedures were completed successfully in all patients. No blood loss or complications were observed. The mean operative time was 54.5 min, and the average hospital stay was 30 h. During a follow-up at 11 months, all patients were cured, except for one who presented urethral erosion. Conclusions The T-LESS technique for removal of eroded meshes is a safe and effective method. The precise access to the bladder minimizes morbidity, and suturing the bladder wall defects may reduce the risk of recurrence.
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Affiliation(s)
- Maciej Przudzik
- Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Ul. Oczapowskiego 2, 10-719, Olsztyn, Poland.
| | - Michał Borowik
- Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Ul. Oczapowskiego 2, 10-719, Olsztyn, Poland
| | - Mirosław Łesiów
- Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Ul. Oczapowskiego 2, 10-719, Olsztyn, Poland
| | - Roman Łesiów
- Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Ul. Oczapowskiego 2, 10-719, Olsztyn, Poland
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Goujon E, Jarniat A, Bardet F, Bergogne L, Delorme E. Retrospective study on the management and follow-up of 18 patients with a mid-urethral sling penetrating the urethra or bladder. J Gynecol Obstet Hum Reprod 2018; 47:289-297. [PMID: 29783036 DOI: 10.1016/j.jogoh.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 05/11/2018] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
Abstract
INTRODUCTION The mid-urethral sling (MUS) procedure is the gold-standard for the surgical treatment of stress urinary incontinence (SUI). Urethro-vesical sling exposure is one of the most serious complications of this procedure. We describe the treatment and follow-up of 18 patients with bladder or urethral sling exposure. PATIENTS AND METHODS This single-center, retrospective study assessed the diagnosis and management of MUS penetrating the lower urinary tract in 18 women. The lesions included were classed as 4B, T3-4, S3 according to the international classification of complications related to the insertion of prostheses. Diagnosis was confirmed by flexible urethro-cystoscopy. The patients were treated surgically. In all cases, the aim was to remove all synthetic materials eroding the bladder or urethra. The patients were reassessed 6 weeks after the procedure, and functional urologic sequelae were treated. Urologic symptoms were evaluated using the USP questionnaire and urologic comfort was assessed using the Contilife questionnaire. RESULTS Seven MUSs were retro-pubic and 11 were trans-obturators. The material was 11 polypropylene macroporous monofilament, four polypropylene silicone coated and three non-available. There were six cases of urethral sling exposure, nine cases of bladder sling exposure, and three cases of urethral and bladder sling exposure, including five complicated cases of lithiasis and one urethra-vaginal fistula. Thirteen patients underwent one surgical procedure, four underwent two, and one underwent five procedures. Seven patients received a Martius flap. Three surgical approaches were necessary: (i) vaginal approach; (ii) urologic (urethral and suprapubic) cystoscopy approach; and (iii) laparoscopy approach. Median follow-up time was 34.5 months. At the end of follow-up, 17/18 patients had no sling exposure from the MUS, and 12/13 patients were considered comfortable from a functional urologic viewpoint. CONCLUSION Our study showed that surgery could treat urethro-vesical sling exposure. Three surgical approaches may be necessary. Controlled cystoscopy is vital to confirm healing due to the recurrences of sling exposure in our study.
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Affiliation(s)
- Edouard Goujon
- Department of Gynecology, Private Hospital Sainte Thérèse, 6 quai du mas Coulet, 34200 Sète, France.
| | | | - Florian Bardet
- Department of Urology, University Hospital of Dijon, France
| | - Lise Bergogne
- Department of Gynecology, Private Hospital Sainte Thérèse, 6 quai du mas Coulet, 34200 Sète, France
| | - Emmanuel Delorme
- Department of Urology, Private Hospital Sainte Marie, Ramsay General de Santé, 4 allée Saint Jean des Vignes, 71100 Chalon-sur-Saône, France
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Laparoscopic Approach for Intravesical Surgery Using Pneumovesicum in Urology: Literature Review. Int Neurourol J 2018; 22:S10-22. [PMID: 29385784 PMCID: PMC5798636 DOI: 10.5213/inj.1836022.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/19/2018] [Indexed: 12/27/2022] Open
Abstract
Minimally invasive laparoscopic surgical procedures are increasingly being used in the management of various urological diseases. In particular, the laparoscopic approach for intravesical surgery using pneumovesicum (LPV) is a minimally invasive alternative with potential advantages including decreased morbidity, shorter hospital stays, and improved cosmesis. We review the applications of LPV in urology, summarize data for different surgical approaches, and provide an overview of patient management, as well as other considerations. This narrative review focused primarily on articles indexed in PubMed, Google Scholar, Scopus, and Embase databases. No formal search strategy was used, and no meta-analysis of data was performed.
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Başıbüyük İ, Tosun M, Kalkan S, Tepeler A. Removal of a retroperitoneal foreign body through single port laparoscopy using nephroscope. Turk J Urol 2017; 43:386-389. [PMID: 28861317 DOI: 10.5152/tud.2017.14306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/04/2016] [Indexed: 11/22/2022]
Abstract
Foreign bodies are rare and challenging issues leading to symptoms according to the location. Laparoscopy is a popular and minimally invasive method used for removal of foreign bodies in the abdominal cavity or retroperitoneum. We herein report a case with retroperitoneal foreign body that was removed through retroperitoneal single- port laparoscopy using nephroscope. To our knowledge this is the first case of removal of a retroperitoneal foreign body through single- port laparoscopy using nephroscope.
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Affiliation(s)
- İsmail Başıbüyük
- Department of Urology, Bezmialem Vakif University School of Medicine, İstanbul, Turkey
| | - Muhammed Tosun
- Department of Urology, Bezmialem Vakif University School of Medicine, İstanbul, Turkey
| | - Senad Kalkan
- Department of Urology, Bezmialem Vakif University School of Medicine, İstanbul, Turkey
| | - Abdulkadir Tepeler
- Department of Urology, Bezmialem Vakif University School of Medicine, İstanbul, Turkey
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Hengel AR, Carlson KV, Baverstock RJ. Prevention, diagnosis, and management of midurethral mesh sling complications. Can Urol Assoc J 2017; 11:S135-S140. [PMID: 28616113 DOI: 10.5489/cuaj.4639] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Midurethral slings (MUS) are a proven effective treatment option for stress urinary incontinence (SUI) and have become the gold standard in most centres in North America. MUS implantation can be associated with risks that are common to all anti-incontinence surgeries, and others which are unique. This article reviews the intraoperative and the early and late postoperative risks associated with these procedures, with insights into their prevention, diagnosis, and management drawn from the literature and expert opinion. In most cases, careful patient counselling before and after surgery, along with meticulous surgical technique, can mitigate risk and patient concern. Even in the best of hands, however, complications will occur, so surgeons must have a high index of suspicion and a low threshold to investigate.
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Affiliation(s)
- A Ross Hengel
- Faculty of Medicine, University of British Columbia, Prince George, BC; Canada
| | - Kevin V Carlson
- Section of Urology, Department of Surgery, University of Calgary, Calgary, AB; Canada
| | - Richard J Baverstock
- Section of Urology, Department of Surgery, University of Calgary, Calgary, AB; Canada.,vesia [Alberta Bladder Centre], Calgary, AB; Canada
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Eroded Tape: A Case of an Early Vesicoscopy Rather Than Laser Melting. Urology 2017; 102:247-251. [DOI: 10.1016/j.urology.2016.09.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/10/2016] [Accepted: 09/13/2016] [Indexed: 11/20/2022]
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Umbilical laparoendoscopic partial cystectomy. Actas Urol Esp 2015; 39:451-5. [PMID: 25749459 DOI: 10.1016/j.acuro.2014.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To present our center's experience in single-port umbilical laparoendoscopic partial cystectomies, in both benign and malignant pathologies. Patient characteristics, perioperative aspects and the surgical techniques used are reviewed. MATERIAL AND METHOD Since May 2012, five patients have undergone a transumbilical single-port laparoendoscopic partial cystectomy with curved equipment through a reusable multichannel system and a 3.5mm accessory trocar. Patients were three males and two females aged between 28 and 78 (median: 44±42.5) years. The etiologies were endometriosis (in 2 cases), a tumor in the diverticulum, a congenital bladder diverticulum and ureterocele (1 case of each). RESULTS Median surgery time was 273±163.4minutes, and intraoperative bleeding 250±175ml. None of the patients required transfusion. The postoperative period was uneventful, with good results and no complications. The hospital stay was 3±1 days. With monitoring of 20±17.5 months, morphological and functional recovery in the bladder and ureter was confirmed in all cases and the patient with neoplastic disease was disease-free more than 2 years after the surgery. CONCLUSIONS An umbilical laparoendoscopic partial cystectomy represents a viable surgical option and ensures that excellent surgical and cosmetic results are achieved.
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Mahapatra RS, Priyadarshi V, Madduri VKS, Pal DK. Transrectal impalement of an incense stick in a child presenting as foreign body in the urinary bladder. BMJ Case Rep 2014; 2014:bcr-2014-204689. [PMID: 24925539 DOI: 10.1136/bcr-2014-204689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The diversity of objects that can be found in the urinary bladder often surpasses the urologist's imagination and mostly they are introduced per urethrally. Impalement injuries of the rectum with bladder perforation have been rarely reported. A high index of clinical suspicion is required to make the diagnosis of bladder perforation while assessing patients presenting with rectal impalement. In this interesting case, a young male child presented with haematuria and dysuria. He had a history of accidentally sitting on an agarbatti (Indian incense stick) stand while playing, followed by perianal pain which subsided spontaneously. Next day he presented with haematuria and dysuria. Clinical examination was inconclusive. On thorough investigation, a linear echogenic foreign body was found in the urinary bladder. The child was operated and the foreign body (incense stick) was removed. This is the first reported case of rectal impalement injury with incense stick, migrated to the urinary bladder in a 2-year-old child.
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Affiliation(s)
- Rajkumar Singha Mahapatra
- Department of Urology, Post Graduate Institute of Medical Education & Research, Kolkata, West Bengal, India
| | - Vinod Priyadarshi
- Department of Urology, Post Graduate Institute of Medical Education & Research, Kolkata, West Bengal, India
| | - Vijay Kumar Sarma Madduri
- Department of Urology, Post Graduate Institute of Medical Education & Research, Kolkata, West Bengal, India
| | - Dilip Kumar Pal
- Department of Urology, Post Graduate Institute of Medical Education & Research, Kolkata, West Bengal, India
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