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Rabani SM, Rabani S. Early detection and endoscopic management of post cesarean section ureterovaginal fistula: a case series study. Int Urogynecol J 2020; 32:2537-2541. [PMID: 33175224 DOI: 10.1007/s00192-020-04589-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to evaluate the endourologic management of post-cesarean section ureterovaginal fistula. METHODS Between February 2016 and March 2019, eight patients presented because of vaginal leakage after cesarean section. All presented within 15 days from their original operations. Three of the patients had a vague lower abdominal pain, and five had ipsilateral flank pain; all had vaginal leakage. Physical examination, ultrasonography, and IVP were done to confirm the diagnosis. Ureteroscopy was the first treatment attempt, using two or three guide wires to find the proximal part of the ureter and insert a JJ stent. RESULTS In six patients, we could insert guide wires, find the proximal part of the ureter, and finally insert a JJ stent. In two patients, we could not even pass a guide wire, so we changed the position, and ureteral reimplantation was done. The stents were removed after 6 weeks, and after 3 months an IVP was planned again that showed all fistulae had resolved with no evidence of ureteral stricture. CONCLUSION In cases of ureterovaginal fistula after cesarean section, ultrasonography and IVP with lateral view x-ray films may confirm the diagnosis. The traditional treatment for ureterovaginal fistula is ureteral reimplantation, but endoscopic management may be a viable technique with less invasiveness and faster results and recovery. Thus, retrograde stenting can be accomplished in selected patients with ureterovaginal fistula after cesarean section and may eliminate the need for reimplantation of the ureter.
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Affiliation(s)
| | - Seyedhossein Rabani
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Kahriman G, Özcan N, Doğan A, İmamoğlu H, Demirtaş A. Percutaneous antegrade ureteral stent placement: single center experience. ACTA ACUST UNITED AC 2019; 25:127-133. [PMID: 30860076 DOI: 10.5152/dir.2019.18252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to present our clinical experience with percutaneous antegrade ureteral stent placement in a single center. METHODS Electronic records of patients who underwent percutaneous image-guided ureteral stent placement between September 2005 and April 2017 were reviewed. A total of 461 patients (322 males, 139 females; age range, 19-94 years; mean age, 61.4±15 years) were included in the study. Patients were classified into two main groups: those with neoplastic disease and those with non-neoplastic disease. Failure was defined as persistence of high level of serum creatinine or an inability to place stents percutaneously. Postprocedural complications were grouped as percutaneous nephrostomy and stent placement related complications. RESULTS A total of 727 procedures in 461 patients were included in the study: 654 procedures (90%) in 407 patients (88.3%) were in the neoplastic group and 73 procedures (10%) in 54 patients (11.7%) were in the non-neoplastic group. Our technical success rates were 97.7% and 100% and complication rates were 3.1% and 4.1% in neoplastic and non-neoplastic groups, respectively. Seven stents retrievals and 112 balloon dilatations were performed successfully. CONCLUSION Percutaneous antegrade ureteral stent placement is a safe and effective method for management of ureteral injuries and obstructions due to both malignant and benign causes when the retrograde approach has failed.
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Affiliation(s)
- Güven Kahriman
- Departments of Radiology, Erciyes University School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Nevzat Özcan
- Departments of Radiology, Erciyes University School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Aytaç Doğan
- Departments of Radiology, Erciyes University School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Hakan İmamoğlu
- Departments of Radiology, Erciyes University School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Abdullah Demirtaş
- Departments of Urology, Erciyes University School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
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Iwamoto G, Kawahara T, Takeshima T, Ninomiya S, Takamoto D, Mochizuki T, Kuroda S, Yao M, Uemura H. Successful treatment of ureteral stricture after total hysterectomy: An antegrade ureteroscopic approach facilitates the insertion of a guidewire for endoscopic dilation. IJU Case Rep 2019; 2:140-142. [PMID: 32743395 PMCID: PMC7292084 DOI: 10.1002/iju5.12061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/20/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Iatrogenic ureteral injury is sometimes seen in daily clinical practice, and gynecological surgery carries the highest risk of ureteral injury among iatrogenic surgical ureteral injury. Case presentation A 61‐year‐old woman was referred to our department for right ureteral stricture and hydronephrosis after total hysterectomy. We initially attempted ureteral stenting, but hydronephrosis redeveloped 1 month after ureteral stent removal. We performed ureteroscopy via an antegrade approach and successfully incised and dilated the ureter. Conclusion We encountered a case of severe ureteral stenosis after total hysterectomy that was successfully treated endoscopically using ureteroscopy via an antegrade approach.
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Affiliation(s)
- Genta Iwamoto
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Takashi Kawahara
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Teppei Takeshima
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Sahoko Ninomiya
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Daiji Takamoto
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Taku Mochizuki
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Shinnosuke Kuroda
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Masahiro Yao
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Hiroji Uemura
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
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Wang Z, Chen Z, He Y, Li B, Wen Z, Chen X. Laparoscopic ureteroureterostomy with an intraoperative retrograde ureteroscopy-assisted technique for distal ureteral injury secondary to gynecological surgery: a retrospective comparison with laparoscopic ureteroneocystostomy. Scand J Urol 2017; 51:329-334. [PMID: 28388304 DOI: 10.1080/21681805.2017.1304989] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to compare the operative and postoperative outcomes of laparoscopic ureteroureterostomy (LAP-UU) using a retrograde ureteroscopy-assisted technique with laparoscopic ureteroneocystostomy (LAP-UNC) in treating ureteral injury after gynecological surgery. MATERIALS AND METHODS The study analyzed 60 ureteral injury repairs performed between May 2010 and February 2016 in patients who underwent either LAP-UU using the retrograde ureteroscopy-assisted technique (n = 26) or LAP-UNC (n = 34). Demographic parameters, operative variables and perioperative outcomes were retrospectively analyzed. The chi-squared test, Fisher's exact test and Student's t test were used for statistical analyses. RESULTS Demographic and clinical data revealed no significant differences between patients in each group in terms of age, body mass index, length of obstruction, incidence of postoperative urinary leakage, incidence of urinary tract infection during hospitalization, oral antibiotics, mean hospital stay, incidence of recurrent obstruction, rate of conversion to open surgery and mean operative time. The LAP-UU group had significantly less estimated blood loss (85 ± 40 vs 120 ± 35 ml, p = .0006) and a significantly lower incidence of vesicoureteral reflux (grade I) on cystography (0/26 vs 6/34, p = .031) during a mean follow-up of 36.5 months (range 7-71 months). CONCLUSIONS Compared with LAP-UNC, LAP-UU is also a technically feasible and safe option for repairing distal ureteral injury secondary to gynecological surgery. The intraoperative retrograde ureteroscopy-assisted technique during LAP-UU contributes to precise localization of the lesion, reduces intraoperative bleeding, enables sufficient dissection of the intramural ureter and preserves its natural antireflux mechanism.
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Affiliation(s)
- Zhaohui Wang
- a Department of Urology , Xiangya Hospital, Central South University , Changsha , Hunan , PR China
| | - Zhi Chen
- a Department of Urology , Xiangya Hospital, Central South University , Changsha , Hunan , PR China
| | - Yao He
- a Department of Urology , Xiangya Hospital, Central South University , Changsha , Hunan , PR China
| | - Bingsheng Li
- a Department of Urology , Xiangya Hospital, Central South University , Changsha , Hunan , PR China
| | - Zhiqiang Wen
- a Department of Urology , Xiangya Hospital, Central South University , Changsha , Hunan , PR China
| | - Xiang Chen
- a Department of Urology , Xiangya Hospital, Central South University , Changsha , Hunan , PR China
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Chung D, Briggs J, Turney BW, Tapping CR. Management of iatrogenic ureteric injury with retrograde ureteric stenting: an analysis of factors affecting technical success and long-term outcome. Acta Radiol 2017; 58:170-175. [PMID: 27012280 DOI: 10.1177/0284185116638568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Iatrogenic ureteral injuries arise as serious complication following obstetrics, gynecological, general, and urological surgery with incidence in the range of 0.5-10%. Retrograde placement of double-J ureteric stent is a possible treatment option if the injury is not recognized at the time of surgery. Purpose To assess technical success and long-term outcome associated with retrograde ureteric stent insertion for iatrogenic ureteric injury. Material and Methods Between 1999 and 2011, 26 patients with initially unrecognized iatrogenic ureteric injury underwent initial management with retrograde ureteric stenting. Full case-notes were available for review in 25 patients. Results The mean interval from injury to attempted stenting was 19.4 days. Successful retrograde ureteric stenting was achieved in 21/25 patients (81%). Retrograde stenting failed in four patients, and nephrostomy followed by alternative procedures were performed instead. At a median follow-up interval of 9.7 months, normal anatomy was demonstrated on 12/21 patients (57%) and a stricture was observed in 6/21 patients (28%) with three requiring surgical intervention. Conclusion Retrograde stenting is a safe and efficient initial management in patients with iatrogenic ureteric injuries.
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Affiliation(s)
- Daniel Chung
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - James Briggs
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
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Zinman LN, Vanni AJ. Surgical Management of Urologic Trauma and Iatrogenic Injuries. Surg Clin North Am 2016; 96:425-39. [DOI: 10.1016/j.suc.2016.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pastore AL, Palleschi G, Silvestri L, Leto A, Autieri D, Ripoli A, Maggioni C, Al Salhi Y, Carbone A. Endoscopic Rendezvous Procedure for Ureteral Iatrogenic Detachment: Report of a Case Series with Long-Term Outcomes. J Endourol 2015; 29:415-20. [DOI: 10.1089/end.2014.0474] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Antonio Luigi Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Giovanni Palleschi
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Luigi Silvestri
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Antonino Leto
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Domenico Autieri
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Andrea Ripoli
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Cristina Maggioni
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Yazan Al Salhi
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Antonio Carbone
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
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Morey AF, Brandes S, Dugi DD, Armstrong JH, Breyer BN, Broghammer JA, Erickson BA, Holzbeierlein J, Hudak SJ, Pruitt JH, Reston JT, Santucci RA, Smith TG, Wessells H. Urotrauma: AUA guideline. J Urol 2014; 192:327-35. [PMID: 24857651 DOI: 10.1016/j.juro.2014.05.004] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE The authors of this guideline reviewed the urologic trauma literature to guide clinicians in the appropriate methods of evaluation and management of genitourinary injuries. MATERIALS AND METHODS A systematic review of the literature using the MEDLINE® and EMBASE databases (search dates 1/1/90-9/19/12) was conducted to identify peer-reviewed publications relevant to urotrauma. The review yielded an evidence base of 372 studies after application of inclusion/exclusion criteria. These publications were used to inform the statements presented in the guideline as Standards, Recommendations or Options. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate) or C (low). In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. RESULTS Guideline statements were created to inform clinicians on the initial observation, evaluation and subsequent management of renal, ureteral, bladder, urethral and genital traumatic injuries. CONCLUSIONS Genitourinary organ salvage has become increasingly possible as a result of advances in imaging, minimally invasive techniques, and reconstructive surgery. As the field of genitourinary reconstruction continues to evolve, clinicians must strive to approach clinical problems in a creative, multidisciplinary, evidence-based manner to ensure optimal outcomes.
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Affiliation(s)
- Allen F Morey
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Steve Brandes
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Daniel David Dugi
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - John H Armstrong
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Benjamin N Breyer
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Joshua A Broghammer
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Bradley A Erickson
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Jeff Holzbeierlein
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Steven J Hudak
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Jeffrey H Pruitt
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - James T Reston
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Richard A Santucci
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Thomas G Smith
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Hunter Wessells
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
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Minimally Invasive Management of Iatrogenic Ureteral Injuries with Ureteroscope Facilitated by Holmium Yttrium-Aluminum-Garnet Laser. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:307963. [PMID: 27355036 PMCID: PMC4897557 DOI: 10.1155/2014/307963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 09/28/2014] [Accepted: 10/04/2014] [Indexed: 11/29/2022]
Abstract
The ureter is vulnerable during general, gynecologic, and urologic surgeries. The traditional open surgical approaches to treating the iatrogenic ureteral injuries have shown several disadvantages such as relatively high rate of severe complications. Although the applications of endourological techniques for management of lower ureteral strictures have been routinely introduced over the last 10 years, most of the different modalities were based on the utilization of hydrophilic instruments that can facilitate the traversal of strictures surrounded by the sutures with gradually increasing force. Interestingly, we have revealed the Ho:YAG laser as the outstanding auxiliary approach to incising the sutures during the ureteroscopy for its well-controlled penetration depth, minimal scarring, and precise cutting. As far as we know, the combined utilization of Ho:YAG laser to incise the sutures responsible for the strictures and double J ureteral stent for drainage has not been extensively reported. Normal ureters of the patients managed by this novel approach were shown by the follow-up 3-4 months later, which demonstrated that the available technique was promising to effectively treat the iatrogenic ureteral injuries.
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Iatrogenic Obliteration of Ureter with Spontaneous Recanalization. Case Rep Med 2013; 2013:290725. [PMID: 24082886 PMCID: PMC3776540 DOI: 10.1155/2013/290725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 08/02/2013] [Indexed: 11/17/2022] Open
Abstract
We report an unusual case of spontaneous and complete healing of a severe iatrogenic midureteral injury. Following percutaneous nephrostomy and 3 months on our surgical waiting list, the injured ureter underwent complete spontaneous recanalization. The patient is clinically well with no evidence of recurrent obstruction after 2 years of followup. To our knowledge, this is the first reported case of spontaneous recanalization of an iatrogenically induced complete ureteral obliteration.
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Postoperative ascites of unknown origin after laparoscopic gynecologic surgery: a 5-year experience of 8 cases and review of the literature. Surg Laparosc Endosc Percutan Tech 2012; 22:e129-31. [PMID: 22678332 DOI: 10.1097/sle.0b013e318247cd90] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We performed an observational study over 5 years on patients with postoperative ascites who had undergone laparoscopic surgery in our hospital. METHODS Patients with postoperative ascites of unknown origin were monitored in the hospital from July 2006 to June 2010. Clinical manifestations, biochemical analysis, and treatment are discussed in the study. RESULTS Of 21,380 laparoscopic surgeries, 8 cases of postoperative ascites of unknown origin were identified in otherwise healthy women. None of the patients revealed any definitive causes even after an extensive diagnostic work-up and recovered uneventfully with general supportive treatments. CONCLUSIONS Postoperative ascites of unknown origin are a rare complication of laparoscopic gynecologic surgery. We surmised that the most likely cause of the ascites is a diffuse peritoneal injury by some substances used during the operation, and supportive therapy is very important.
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Park JH, Park JW, Song K, Jo MK. Ureteral injury in gynecologic surgery: a 5-year review in a community hospital. Korean J Urol 2012; 53:120-5. [PMID: 22379592 PMCID: PMC3285707 DOI: 10.4111/kju.2012.53.2.120] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 10/24/2011] [Indexed: 11/25/2022] Open
Abstract
Purpose We reviewed the cases of ureteral injury during gynecologic surgeries in a community hospital and attempted to find possible options for alleviating these distressing situations. Materials and Methods A total of 2,927 patients underwent gynecologic surgeries in the last 5 years at our hospital. We retrospectively analyzed the cases, particularly the possible risk factors and management according to the time of detection of the injury. Thirty-five cases (1.2%) were identified with ureteral injury in a total of 2,927 gynecologic surgeries. Risk factors included endometriosis, pelvic inflammatory disease, previous pelvic surgery, history of pelvic radiation, and congenital anomalies. Among 2,927 patients, 522 had predisposing factors for ureteral injuries. Results The incidence of ureteral injury in laparoscopic cases was 1.1%, similar to the cases of laparotomy (1.2%). The rate of ureteral injury was significantly higher in the group with risk factors (2.7%) than in the group without risk factors (0.9%; p=0.002). Prophylactic ureteral stenting was performed in 101 of 522 patients with risk factors according to the gynecologic surgeon's preference. The injury rate (1.0%) in the stenting group was lower than that in the non-stenting group (3.1%; p=0.324). Management of ureteral injuries was successful in all cases. Of the patients with postoperatively diagnosed injuries, two patients were managed with secondary procedures, such as retrograde balloon dilatation or ureteroneocystostomy. Conclusions The incidence of ureteral injury was significantly higher in cases having risk factors than in cases without risk factors. Surgeons should be cautious to avoid ureteral injury during gynecologic surgery, especially in patients with risk factors.
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Affiliation(s)
- Jeong Hyun Park
- Department of Urology, Korea Cancer Center Hospital, Seoul, Korea
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Koukouras D, Petsas T, Liatsikos E, Kallidonis P, Sdralis EK, Adonakis G, Panagopoulos C, Al-Aown A, Decavalas G, Perimenis P, Siablis D, Karnabatidis D. Percutaneous minimally invasive management of iatrogenic ureteral injuries. J Endourol 2010; 24:1921-7. [PMID: 20964484 DOI: 10.1089/end.2010.0153] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To present experience with the percutaneous management of iatrogenic ureteral injuries. PATIENTS AND METHODS Eighteen women and six men with a mean age of 59.3 years (range 33-80 years) received a diagnosis of ureteral injury sustained during gynecologic, urologic, and general surgical procedures. In a total of 25 injured ureters, 12 had interruption of continuity of their lumen, 10 were associated with contrast extravasation, and 3 were related to both. A standard percutaneous nephrostomy tract was established on the side of the afflicted kidney. Combined use of hydrophilic guidewires and balloon dilations were performed to achieve antegrade recanalization of the ureteral lesion. Then, a ureteral stent was inserted to assure patency. RESULTS Average stricture length was 1.21 (range 0.5-1.9 cm). Success of the aforementioned technique was possible in 18 ureters. Successful management in one session took place in 14 ureters. Average hospitalization time was 1.8 days (range 0-5 d). The follow-up period ranged between 12 and 18 months, with mean follow-up time of 12.9 months. Ureteral patency was evident at 1 week follow-up in six patients with obstructed ureters. In the remaining patients, balloon dilation of the stricture was repeated, and another stent was placed. Extravasation of contrast was observed in two patients with extravasating ureters in the same period. Nephrostomy tubes were removed after a mean indwelling period of 5.9 weeks (range 1-12 wks). Two patients treated by the described method died during their hospitalization in the intensive care unit because of sepsis from peritonitis that was related to colon injury and multiple concomitant injuries. Major complications were not observed in the remaining 22 patients during the follow-up period. CONCLUSION The minimally invasive management of ureteral injuries is a safe and efficient method for both ureteral obstruction and/or laceration in a wide range of iatrogenic ureteral injuries.
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Arrabal-Polo MA, Arrabal-Martin M. Resolution of right ureteral lesion after subtotal hysterectomy due to benign pathology. A clinical case study. Int Urogynecol J 2010; 21:1435-7. [PMID: 20571768 DOI: 10.1007/s00192-010-1169-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 04/10/2010] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Ureteral lesion during gynecological surgery to correct benign uterine pathology is around 0.03-2.0%, and usually occurs at the ligature of blood vessels. CLINICAL CASE HISTORY At the end of 3 months, the patient does not manifest any symptoms and does exhibit a good bilateral renal function. Ureteral lesions resulting from gynecological surgery represent a medico-legal problem, which is not a negligible issue for the current healthcare system, so it is necessary to conduct a correct pre-operative and intra-operative assessment to prevent such lesions. DISCUSSION We describe here the case story of a 40-year-old female patient, who, after subtotal hysterectomy for myomas, presented with acute abdominal pain, and was diagnosed with a right ureteral lesion, via CAT imaging; the patient received direct ureterovesical implantation of double J catheter, which was kept in place for 8 weeks.
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Conley SP, Lee BR, Hyams ES, Shah O, Karnabatidis D, Kallidonis P. Controversial case in endourology. J Endourol 2010; 24:899-903. [PMID: 20491570 DOI: 10.1089/end.2010.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sarah P Conley
- Tulane University School of Medicine , New Orleans, Louisiana, USA
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Double-J stenting: initial management of injured ureters recognized late after gynecological surgery. Int Urogynecol J 2010; 21:699-703. [DOI: 10.1007/s00192-009-1092-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 12/27/2009] [Indexed: 11/25/2022]
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