1
|
Faiella E, Pacella G, Vergantino E, Santucci D, De Cicco Nardone C, Terranova C, Plotti F, Angioli R, Beomonte Zobel B, Grasso RF. The Rendezvous Technique: A Minimally Invasive Non-Surgical Approach for the Management of Iatrogenic Ureteral Injuries. J Clin Med 2024; 13:3820. [PMID: 38999385 PMCID: PMC11242380 DOI: 10.3390/jcm13133820] [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: 06/09/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: The aim of our study is to evaluate the feasibility and efficacy of the rendezvous technique for the treatment of iatrogenic ureteral injuries. Methods: From 2014 to 2019, 29 patients treated with the rendezvous technique for mono- or bilateral iatrogenic ureteral injuries were enrolled in this retrospective study. All the leaks were previously assessed by CT-urography and antegrade pyelography. Ureteral continuity was restored by performing the rendezvous technique, combining antegrade trans-nephrostomic access and a retrograde trans-cystostomic approach. A double J stent was antegradely inserted, and a nephrostomy tube was kept in place at the end of the procedure. A post-procedure CT-urography and a 30-day nephrostogram follow-up were performed. In the absence of a contrast leak, the nephrostomy tube was removed. Patient follow-up was set with CT-urography at 3, 6, and 12 months and stent substitution every 4 months. The CT-urography was performed to confirm the restored integrity of the ureter before stent removal. Results: The rendezvous technique was successful in all cases with the resolution of the ureteral leak. No major complications were observed. In all the patients, the nephrostomy tube was removed after 30 days. After performing CT-urography, the stent was removed permanently after 12 months. Only three cases showed local post-treatment stenosis treated with surgical ureteral reimplantation. Conclusions: The rendezvous technique is a safe and effective minimally invasive procedure that can be used to restore the continuity of the ureter, avoiding open surgery and providing valuable support for the management of complications after gynecological surgery.
Collapse
Affiliation(s)
- Eliodoro Faiella
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.P.); (E.V.); (D.S.); (B.B.Z.); (R.F.G.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Giuseppina Pacella
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.P.); (E.V.); (D.S.); (B.B.Z.); (R.F.G.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Elva Vergantino
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.P.); (E.V.); (D.S.); (B.B.Z.); (R.F.G.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Domiziana Santucci
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.P.); (E.V.); (D.S.); (B.B.Z.); (R.F.G.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Carlo De Cicco Nardone
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.D.C.N.); (C.T.); (F.P.); (R.A.)
| | - Corrado Terranova
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.D.C.N.); (C.T.); (F.P.); (R.A.)
| | - Francesco Plotti
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.D.C.N.); (C.T.); (F.P.); (R.A.)
| | - Roberto Angioli
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.D.C.N.); (C.T.); (F.P.); (R.A.)
| | - Bruno Beomonte Zobel
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.P.); (E.V.); (D.S.); (B.B.Z.); (R.F.G.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Rosario Francesco Grasso
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.P.); (E.V.); (D.S.); (B.B.Z.); (R.F.G.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| |
Collapse
|
2
|
Takahashi T, Maruno K, Hazama T, Ota H, Yamada Y, Nakashima M, Kikkawa K, Tamaki M, Ito N. A case of one-stage laparoscopic drainage and ureterocystoneostomy for iatrogenic ureteral injury associated with infected urinoma. IJU Case Rep 2023; 6:406-409. [PMID: 37928275 PMCID: PMC10622193 DOI: 10.1002/iju5.12635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/23/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Iatrogenic ureteral injury is a rare but often encountered complication of abdominal and gynecological surgery. This is a case of iatrogenic ureteral injury with infected urinoma treated with one-stage laparoscopic drainage and ureterocystoneostomy. Case presentation An 80-year-old man with rectal cancer had robot-assisted low anterior rectum resection and left lateral lymph node dissection after colostomy and preoperative chemoradiotherapy. On the 14th postoperative day, he had a fever, and a noncontrast-enhanced computed tomography scan revealed a low-density polycystic area in the left pelvic cavity. Retrograde pyelography revealed contrast medium leaking from the left lower ureter, preventing ureteral stent placement. We identified it as a delayed ureteral injury with infected urinoma and performed laparoscopic one-stage drainage and ureterocystoneostomy. Conclusion This study reported a case of one-stage laparoscopic drainage and ureterocystoneostomy for iatrogenic ureteral injury with infected urinoma.
Collapse
Affiliation(s)
- Toshifumi Takahashi
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Kouhei Maruno
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Tatsuya Hazama
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Hideto Ota
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Yuya Yamada
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Masakazu Nakashima
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Kazuro Kikkawa
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Masahiro Tamaki
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Noriyuki Ito
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| |
Collapse
|
3
|
Chen K, Lawrentschuk N. Case of the Month from Peter MacCallum Cancer Centre, Melbourne, Australia: ICG-assisted robotic Boari flap ureteric reimplantation in a case of missed ureteric injury. BJU Int 2023; 131:46-49. [PMID: 36546722 DOI: 10.1111/bju.15867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Kenneth Chen
- Department of Genitourinary Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Urology, Singapore General Hospital, Singapore City, Singapore
| | - Nathan Lawrentschuk
- Department of Genitourinary Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic., Australia.,EJ Whitten Prostate Cancer Research Centre at Epworth Healthcare, Melbourne, Vic., Australia
| |
Collapse
|
4
|
A rare complication of urinary catheter insertion: Proximal ureteric rupture and sepsis. Urol Case Rep 2022; 45:102185. [PMID: 35991214 PMCID: PMC9382427 DOI: 10.1016/j.eucr.2022.102185] [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: 07/12/2022] [Accepted: 08/04/2022] [Indexed: 11/20/2022] Open
Abstract
Catheter-related injuries to the distal urinary tract are well described however injury to the ureters are very rare. A 76-year-old Caucasian female presented with proximal ureteric rupture and sepsis caused by cannulation of the ureter with a catheter and inflation of the balloon within the lumen. The patient was managed with intravenous antibiotics, nephrostomy and ureteric stenting. Patients with neurogenic bladder may have vesico-ureteric reflux with patulous ureteric orifice. Long-term catheters may result in a contacted bladder, thereby altering the anatomical relationship of the bladder neck and ureteric orifice. Both of which may increase the risk of this complication.
Collapse
|
5
|
Cebeci OÖ. Is endourological intervention a suitable treatment option in the management of iatrogenic thermal ureteral injury? A contemporary case series. BMC Urol 2022; 22:137. [PMID: 36057579 PMCID: PMC9441037 DOI: 10.1186/s12894-022-01094-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iatrogenic ureteral injury (IUI) is relatively rare, however, can cause sepsis, kidney failure, and death. Most cases of IUI are not recognized until the patient presents with symptoms following pelvic surgery or radiotherapy. Recently, minimally invasive approaches have been used more frequently in the treatment of IUI. This study evaluates urological intervention success rates and long-term clinical outcomes according to the type of IUI following hysterectomy. METHODS Twenty-seven patients who underwent surgery due to IUI in our clinic following hysterectomy were evaluated between January 2011 and April 2018. Patients were classified according to the time of diagnosis of IUI. The IUI cases diagnosed within the first 24 h following hysterectomy were designated as "immediate" IUI, while that diagnosed late period was considered 'delayed' IUI. The type of IUI was categorized as "cold transection" if it was due to surgical dissection or ligation without any thermal energy, and "thermal injury" if it was related to any energy-based surgical device. Patient information, laboratory and perioperative data, imaging studies, and complications were assessed retrospectively. RESULTS All cases of delayed diagnosis IUI were secondary to laparoscopic hysterectomy (P = 0.041). Patients with thermal injury to the ureter were mostly diagnosed late (delayed) (P = 0.029). While 31% of the patients who underwent endourological intervention were diagnosed immediately, 69% of them were diagnosed as delayed. These rates were roughly reversed for open reconstructive surgery: 73% and 27% (P = 0.041), respectively. We detected eight ureteral complications in our patient cohort following the urological intervention. In all these failed cases, the cause of IUI was a thermal injury (P = 0.046) and the patients had received endourological treatment (P = 0.005). No complications were detected in patients who undergo open urological reconstructive surgery. While one of the patients who developed urological complications had an immediate diagnosis, seven were in the delayed group (P = 0.016). CONCLUSION Endourological intervention is performed more frequently in delayed diagnosed IUI following hysterectomy, however, the treatment success rate is low if thermal damage has developed in the ureter. Surgical reconstruction is should be preferred in these thermal injury cases to avoid further ureter-related complications.
Collapse
Affiliation(s)
- Oğuz Özden Cebeci
- Department of Urology, Kocaeli Derince Traning and Research Hospital, Saglik Bilimleri University, Ibni Sina Blv 1, 41200, Derince, Kocaeli, Turkey.
| |
Collapse
|
6
|
Kallidonis P, Spiliopoulos S, Papadimatos P, Katsanos C, Liourdi D, Tsaturyan A, Karnabatidis D, Liatsikos E, Kitrou P. Long-term outcomes of paclitaxel-coated balloons for non-malignant ureteral strictures. World J Urol 2022; 40:1231-1238. [PMID: 35246705 DOI: 10.1007/s00345-022-03952-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/28/2022] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate the clinical efficacy and safety of drug-coated balloon (DCB) ureteroplasty for the management of non-malignant ureteral strictures. MATERIAL AND METHODS A prospective "off-label" monocentric single-arm pilot study investigating the safety and efficacy of drug-coated balloon (DCB) (Lutonix®; BD, USA) was performed. Twenty-five patients with benign ureteral strictures related to uretero-enteric anastomosis (n = 13); lithiasis (n = 5), post-surgical complications (iatrogenic n = 5), transplanted kidney (n = 1) and post-radiotherapy (n = 1) were included. Following lesion crossing, predilatation was performed using 4-7 mm high-pressure balloon catheter (5-6Fr) with a balloon pressure of 6-7 atm based on the manufacturer's recommendation. In the absence of rupture of the ureteral wall, the DCB was dilated for 4 min. across the lesion. The process was repeated if deemed necessary to a maximum of three stricture dilatations. We analysed both clinical and radiological primary patency (no signs of ipsilateral hydronephrosis or improvement of the existing residual dilatation at the follow-up examinations) and secondarily safety endpoints. RESULTS Mean lesion length was 40 ± 28.5 mm. Mean time follow up was 36 months ± 10.46 months. Strictures were located at upper ureteric (12%), lower ureteric (32%), ureterovesical anastomosis (4%) and uretero-enteric anastomosis (52%) levels. The overall radiological success at 1-year follow-up was 88% (22/25 patients). In 56% patients (14/25 patients with primary patency) the nephrostomy catheter was removed 21 days following a single DCB procedure. In 32% (8/25 patients) an additional dilatation sessions were required for maintaining the ureteral patency. The overall failure rate at 1-year follow-up was 12% (3/25 patients). Only one case of febrile urinary tract infection in a female patient (acute pyelonephritis) was encountered after the first dilatation. CONCLUSIONS Paclitaxel-coated balloon ureteroplasty proved to be safe and effective for the treatment of non-malignant ureteral strictures. Larger studies are warranted to validate these promising initial results.
Collapse
Affiliation(s)
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Panagiotis Kitrou
- Department of Interventional Radiology, University of Patras, Patras, Greece
| |
Collapse
|
7
|
Halinski A, Halinski A, Halinski P. Olbert's Balloon Dilatation as a Minimally Invasive Possibility of Treating Ureteral Stricture After Complicated URS-L in Children. Front Pediatr 2022; 10:767500. [PMID: 36105858 PMCID: PMC9465309 DOI: 10.3389/fped.2022.767500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 05/30/2022] [Indexed: 11/22/2022] Open
Abstract
Olbert's balloon dilatation is a surgical technique used for the treatment of ureteral stricture. Although it is more frequently used in adults, due to the advancing miniaturization of the equipment, this technique has become possible in children. We would like to present five cases of Olbert's balloon dilatation carried out in children with ureteral stricture, aged 12-17 years. All of these children were diagnosed for at least 6 months. Ureteral stricture has been noticed in those patients with a time of a stone residence in the ureter longer than 6 months. The duration of the stone in the ureter varied from 6 to 18 months. The symptoms were abdominal pain, renal colic pain, UTI, fever, vomiting, and nausea. Ultrasound (US) revealed hydronephrosis and ureter dilatation above the stone. All of these children had grade-3 hydronephrosis based on the Onen grading system during admission to the hospital. The lack of renal function on the DMSA scan was observed with an average of 22%. JJ-stent was inserted as a first-line treatment. A retrograde pyelogram revealed ureteral stricture at a length from 1 to 1.7 cm in the place where the stone was ingrown. Olbert's balloon dilatation under fluoroscopy was performed successfully in all children. We achieved an efficacy of 60% in our series. Renal function increased to an average of 36% on DMSA 3 months after surgery. The level of creatinine is shaped at an average of 0.6. On US, two children had no hydronephrosis while one child had grade-1 hydronephrosis. The longest follow-up is now 4 years, with the same good results. In conclusion, Olbert's balloon dilatation is an effective, safe, and minimally invasive tool for ureteral stricture in the hands of the endourological experienced pediatric urologist. But more prospective, randomized trials are still needed.
Collapse
Affiliation(s)
- Adam Halinski
- Department of Pediatric Urology, Private Medical Center "Klinika Wisniowa", Zielona Góra, Poland.,Department of Clinical Genetics and Pathology, University of Zielona Gora, Zielona Gora, Poland.,Scientific Office, U-merge Ltd., London-Athens-Dubai, Athens, Greece
| | - Andrzej Halinski
- Department of Pediatric Urology, Private Medical Center "Klinika Wisniowa", Zielona Góra, Poland
| | - Paweł Halinski
- Department of Pediatric Urology, Private Medical Center "Klinika Wisniowa", Zielona Góra, Poland
| |
Collapse
|
8
|
Singh A, Parikh D, Surwase PP, Agrawal S, Ganpule A, Sabnis RB, Desai MR. Single ileal segment in a cat-tail configuration for bilateral ureteric strictures. Indian J Urol 2021; 37:325-330. [PMID: 34759523 PMCID: PMC8555567 DOI: 10.4103/iju.iju_140_21] [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: 04/20/2021] [Revised: 07/11/2021] [Accepted: 08/18/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Management of bilateral long length ureteric strictures is difficult with few options for reconstruction. In this report, we describe our experience with the use of a single, 15- 20 cm ileal segment for reconstruction of bilateral long length (involving more than 2/3rd ureter) ureteric strictures. Patients and Methods A retrospective analysis of 5 cases operated between 2015 and 2020for bilateral long length ureteric strictures, using a single segment ileal interposition in a cat tail configuration was performed. We evaluated renal function, surgical success, incidence of urinary tract infection and complications of the procedure. Surgical success was defined as an asymptomatic patient with no hydronephrosis and/or prompt drainage of the kidney on radiological investigations. Results The average age of presentation was 42.8 ± 7.4 years (33-53) years). All the cases were secondary to a gynaecological intervention. The mean creatinine prior to surgery was 0.81 ± 0.36 mg % (range 0.5 -1.4 mg%). Mean duration of follow-up was 28.6 ± 20.6 months (Range 10 - 56 months). Mean hospital stay was 14.4 ± 3.36 days (range 12-20 days). Two patients developed ileus and one patient developed deep venous thrombosis in the post-operative period. One patient developed pyelonephritis within one month of surgery. There was no deterioration of renal function with the mean serum creatinine at last follow-up being 0.9 ± 0.36 mg% (range 0.6 - 1.5 mg%). Conclusion The use of an ileal segment in cat-tail configuration for bilateral simultaneous ileal replacement is a feasible and safe option. The medium-term result states that it is effective in the preservation of renal function and provides a good conduit for drainage.
Collapse
Affiliation(s)
- Abhishek Singh
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Deval Parikh
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | | | - Shashank Agrawal
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Arvind Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - R B Sabnis
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - M R Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
Peng YL, Ning K, Wu ZS, Li ZY, Deng MH, Xiong LB, Yu CP, Zhang ZL, Liu ZW, Lu HM, Zhou FJ. Ureteral stents cannot decrease the incidence of ureteroileal anastomotic stricture and leakage: A systematic review and meta-analysis. Int J Surg 2021; 93:106058. [PMID: 34416355 DOI: 10.1016/j.ijsu.2021.106058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/08/2021] [Accepted: 08/10/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The ileal conduit and ileal orthotopic neobladder were the most popular methods for urinary diversion following radical cystectomy. Stenting the anastomosis of ileo-ureter or ureter-neobladder was a common practice. However, it is still controversial if ureteral stents could prevent complications such as ureteroileal anastomosis stricture (UIAS) and ureteroileal anastomosis leakage (UIAL) after ureteral anastomosis. OBJECTIVES This study aims to investigate the role of the ureteral stent in preventing UIAS and UIAL. DATA SOURCES We systematically searched the related studies in PubMed, Embase, and Cochrane Library up to June 2020. STUDY ELIGIBILITY CRITERIA Cohort studies that identified the use of stent and the incidence of UIAS or UIAL were recorded. DATA SYNTHESIS Comparative meta-analysis was conducted on four cohort studies for comparison of UIAS and UIAL between the stented and nonstented groups. Besides, eleven studies which reported the events of UIAS and UIAL were used for meta-analysis of single proportion. RESULTS A total of 11 studies were qualified for analysis. Comparative meta-analysis identified that the incidence of UIAS was higher in the stented group than that in the nonstented group, but this did not reach a significant difference (odds ratio [OR]: 1.64; 95% confidence interval [CI]: 0.88-3.05; P = 0.12). Besides, there was no difference in the incidences of UIAL between the stented and the nonstented groups. On meta-analysis of single proportion, the incidence of UIAS was 7% (95% CI: 3%-10%) in the stented group and 3% (95% CI: 1%-6%) in the nonstented group. The UIAL rate was 1% (95% CI, 0%-4%) in stented patients and 2% (95% CI, 1%-4%) in nonstented patients. CONCLUSION Stenting the ureteroileal anastomosis resulted in a higher incidence of UIAS. There is no evidence to support ureteral stents could prevent the occurrence of UIAL after urinary diversion.
Collapse
Affiliation(s)
- Yu-Lu Peng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Kang Ning
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Ze-Shen Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Zhi-Yong Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Min-Hua Deng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Long-Bin Xiong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Chun-Ping Yu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Zhi-Ling Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Zhuo-Wei Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Hui-Ming Lu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
| | - Fang-Jian Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
| |
Collapse
|
11
|
Cost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2020; 28:1470-1483. [PMID: 33310171 DOI: 10.1016/j.jmig.2020.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/06/2020] [Accepted: 12/06/2020] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To estimate the rate of lower urinary tract injury (LUTI) and percentage of LUTI needing to be recognized intraoperatively to make universal cystoscopy cost-effective and cost-saving during laparoscopic hysterectomy. DESIGN A decision tree model was used to estimate the costs and quality-adjusted life years associated with delayed or intraoperative recognition of LUTI at the time of laparoscopic hysterectomy. Probabilities and utilities were estimated from published literature. Costs were estimated from Medicare national reimbursement schedules. Threshold analyses estimated the LUTI rate and cystoscopy sensitivity that would make universal cystoscopy cost-effective or cost-saving. Monte Carlo simulations were performed. SETTING US healthcare system. PATIENTS Individuals undergoing laparoscopic hysterectomy for benign indications. INTERVENTIONS Theoretic implementation of a universal cystoscopy policy. MEASUREMENTS AND MAIN RESULTS The total direct medical costs of laparoscopic hysterectomy under usual care were $8831 to $9149 and under universal cystoscopy were $8944 to $9068. When low LUTI rates (0.44%; estimated using sample-weighted estimates of retrospective and prospective data) were assumed, universal cystoscopy was only cost-effective in 17.1% of the simulations; the incremental cost was estimated to be $111 to $131. With median LUTI rates (2.3%) or high LUTI rates (4.0%; estimated using only prospective data with universal screening), the universal cystoscopy strategy was cost-effective in 93.9% and 99.6% of the simulations, respectively, and potentially cost-saving if the sensitivity of intraoperative cystoscopy for ureteral injury exceeded 65% or 31%, respectively. The estimated potential savings were $18 to $95 per hysterectomy. In threshold analysis assuming the average cystoscopy sensitivity rate, universal cystoscopy is estimated to be cost-effective when the LUTI rate exceeds 0.80%. CONCLUSION In our model, universal cystoscopy is the preferred approach for laparoscopic hysterectomy and is estimated to be cost-effective in contemporary clinical settings where the LUTI rate is estimated to be 1.8% and potentially cost-saving among higher-risk populations, including those with endometriosis or pelvic organ prolapse. If the LUTI rates are less than 0.75%, the estimated incremental costs are modest-up to $131 per case. Administrators and providers should consider the local LUTI rates and practice patterns when planning implementation of a universal cystoscopy policy.
Collapse
|
12
|
Coccolini F, Moore EE, Kluger Y, Biffl W, Leppaniemi A, Matsumura Y, Kim F, Peitzman AB, Fraga GP, Sartelli M, Ansaloni L, Augustin G, Kirkpatrick A, Abu-Zidan F, Wani I, Weber D, Pikoulis E, Larrea M, Arvieux C, Manchev V, Reva V, Coimbra R, Khokha V, Mefire AC, Ordonez C, Chiarugi M, Machado F, Sakakushev B, Matsumoto J, Maier R, di Carlo I, Catena F. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg 2019; 14:54. [PMID: 31827593 PMCID: PMC6886230 DOI: 10.1186/s13017-019-0274-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/23/2019] [Indexed: 12/22/2022] Open
Abstract
Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines.
Collapse
Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia, 56124 Pisa, Italy
| | | | - Yoram Kluger
- Division of General Surgery Rambam Health Care Campus, Haifa, Israel
| | - Walter Biffl
- Trauma Surgery Dept., Scripps Memorial Hospital, La Jolla, California USA
| | - Ari Leppaniemi
- General Surgery Dept., Mehilati Hospital, Helsinki, Finland
| | - Yosuke Matsumura
- Department of Emergency and Critical Care Medicine, Chiba University Hospital, Chiba, Japan
| | - Fernando Kim
- Urology Department, University of Colorado, Denver, USA
| | | | - Gustavo P. Fraga
- Trauma/Acute Care Surgery & Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Goran Augustin
- Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta Canada
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Imitiaz Wani
- Department of Surgery, DHS Hospitals, Srinagar, Kashmir India
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Emmanouil Pikoulis
- 3rd Department of Surgery, Attiko Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Martha Larrea
- General Surgery, “General Calixto García”, Habana Medicine University, Havana, Cuba
| | - Catherine Arvieux
- Clin. Univ. de Chirurgie Digestive et de l’Urgence, CHUGA-CHU Grenoble Alpes UGA-Université Grenoble Alpes, Grenoble, France
| | - Vassil Manchev
- General and Trauma Surgery Department, Pietermaritzburg Hospital, Pietermaritzburg, South Africa
| | - Viktor Reva
- General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia
| | - Raul Coimbra
- Department of General Surgery, Riverside University Health System Medical Center, Moreno Valley, CA USA
| | - Vladimir Khokha
- General Surgery Department, Mozir City Hospital, Mozir, Belarus
| | - Alain Chichom Mefire
- Department of Surgery and Obstetrics and Gynecology, University of Buea, Buea, Cameroon
| | - Carlos Ordonez
- Trauma and Acute Care Surgery, Fundacion Valle del Lili, Cali, Colombia
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia, 56124 Pisa, Italy
| | - Fernando Machado
- General and Emergency Surgery Department, Montevideo Hospital, Montevideo, Paraguay
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, Saint-Marianna University School of Medicine, Kawasaki, Japan
| | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Isidoro di Carlo
- Department of Surgical Sciences and Advanced Technologies “GF Ingrassia”, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Li X, Wang P, Liu Y, Liu C. Minimally invasive surgical treatment on delayed uretero-vaginal fistula. BMC Urol 2018; 18:96. [PMID: 30373586 PMCID: PMC6206918 DOI: 10.1186/s12894-018-0410-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
Objective To evaluate the procedure of endoscopic surgery for ureterovaginal fistula (UVF) and its clinical efficacy. Materials and methods A retrospective analysis of 46 patients needing treatment for UVF with endourology technology was conducted (all patients had unilateral ureteric injury, 27 left and 19 right). Transurethral retrograde ureteric stenting or realignment retrograde/antegrade approach stenting was used to treat the fistula, and the relation between treatment and prognosis was analyzed. Results One case failed, the patient undergoing percutaneous nephrostomy instead. Success was achieved in 45 cases, and urinary leakage was stopped 48 h after surgery. Of the 45 patients operated on, 16 had their double-J stents removed after 3–6 months, and 29 needed replacement every 6–12 months. In a postoperative follow-up of 6–36 months, 10 patients had recurrent stenosis needing ureteroscopic endoureterotomy or reexpansion with a balloon. No other complications occurred. Conclusions Endoscopic surgery is an effective technology in the treatment of UVF, with the advantages of being effective, reliable, less invasive, and readily accepted by patients.
Collapse
Affiliation(s)
- Xinying Li
- Department of Urology, The Fourth Hospital of China Medical University, 4 Chongshan Road, Shenyang, 110032, China
| | - Ping Wang
- Department of Urology, The Fourth Hospital of China Medical University, 4 Chongshan Road, Shenyang, 110032, China
| | - Yili Liu
- Department of Urology, The Fourth Hospital of China Medical University, 4 Chongshan Road, Shenyang, 110032, China
| | - Chunlai Liu
- Department of Urology, The Fourth Hospital of China Medical University, 4 Chongshan Road, Shenyang, 110032, China.
| |
Collapse
|
16
|
Tonolini M. Multidetector CT of expected findings and complications after hysterectomy. Insights Imaging 2018; 9:369-383. [PMID: 29626286 PMCID: PMC5990996 DOI: 10.1007/s13244-018-0610-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/12/2018] [Accepted: 02/12/2018] [Indexed: 12/15/2022] Open
Abstract
Abstract Indicated to manage a variety of disorders affecting the female genital tract, hysterectomy represents the second most common gynaecological operation after caesarean section. Performed via an open, laparoscopic or vaginal approach, hysterectomy is associated with non-negligible morbidity and occasional mortality. Iatrogenic complications represent a growing concern for gynaecologists and may result in prolonged hospitalisation, need for interventional procedures or repeated surgery, renal impairment and malpractice claims. As a result, radiologists are increasingly requested to investigate patients with suspected complications after hysterectomy. In the vast majority of early postoperative situations, multidetector CT represents the ideal modality to comprehensively visualise the surgically altered pelvic anatomy and to consistently triage the varied spectrum of possible injuries. This pictorial review provides an overview of current indications and surgical techniques, illustrates the expected CT appearances after recent hysterectomy, the clinical and imaging features of specific complications such as lymphoceles, surgical site infections, haemorrhages, urinary tract lesions and fistulas, bowel injury and obstruction. Our aim is to increase radiologists’ familiarity with normal post-hysterectomy findings and with post-surgical complications, which is crucial for an appropriate choice between conservative, interventional and surgical management. Teaching points • Hysterectomy via open, laparoscopic or vaginal route is associated with non-negligible morbidity. • Multiplanar CT imaging optimally visualises the surgically altered pelvic anatomy. • Familiarity with early post-hysterectomy CT and expected findings is warranted. • Complications encompass surgical site infections, haemorrhages, bowel injury and obstruction. • Urological complications include ureteral leakage, bladder injury, urinomas and urinary fistulas.
Collapse
Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| |
Collapse
|
17
|
Management of urinary-tract fistulas using reversible balloon nephrostomy: a single-center retrospective analysis of 56 patients. Int Urogynecol J 2018; 30:287-292. [PMID: 29546601 DOI: 10.1007/s00192-018-3628-0] [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: 11/16/2017] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To evaluate the effectiveness of balloon nephrostomy (BN) for treating urinary tract fistulas. MATERIALS AND METHODS In a single-center retrospective analysis, 56 patients were treated using BN between 2003 and 2014. All causes of urinary tract fistula were included. We assessed the effectiveness of drainage, complications, and the types of reconstruction surgery used. Success was defined as fistula closure without surgery. RESULTS The cohort consisted of 25 males (54%) and 31 females (55%) with a median age of 63 years who underwent BN for a urinary fistula secondary to surgery, i.e., urologic (40%; n = 22), gynecologic (34%; n = 19), or digestive (20%; n = 11). Of these patients, 48 (86%) had a history of cancer (49% had a tumor progression). Median drainage time was 90 days (10-583), with an average of three successive readjustments needed per patient. We obtained a 21% success rate (n = 12), morbidity was 6.5% (urinary sepsis, renal abscess, ureteral stricture), and 7% of patients developed ureteral stricture after balloon removal. There was no recurrence of any fistula within a median follow-up time of 15.2 months. CONCLUSION This minimally invasive procedure can be used for selected urinary tract fistulas with few complications. It can also be used safely in populations that have several comorbidities.
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
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.
Collapse
|
20
|
Incidence of Iatrogenic Ureteral Injury During Open and Laparoscopic Colorectal Surgery: A Single Center Experience and Review of the Literature. Surg Laparosc Endosc Percutan Tech 2017; 26:513-515. [PMID: 27846171 DOI: 10.1097/sle.0000000000000335] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Iatrogenic ureteral injury is a rare but potentially devastating complication of colorectal surgery. We evaluated the incidence and management of iatrogenic ureteral injuries in colorectal surgery during the transition phase from open to laparoscopic surgery. MATERIALS AND METHODS We conducted a retrospective single center study. All patients who underwent colorectal surgery between 2004 and 2014 were evaluated by collecting data of electronic patient charts. Both acute and elective procedures were included. RESULTS A total of 3302 colorectal procedures were performed in the study period. Of these, 2817 operations were performed open and 484 laparoscopically. A total of 23 iatrogenic ureteral injuries were identified, of which 5 were found during laparoscopic surgery. The cumulative incidence of ureteral injuries was 0.6% for open procedures and 1.0% for laparoscopic procedures. CONCLUSIONS Ureteral injury is a rare complication of colorectal surgery. The incidence might rise with the increasing use of laparoscopy.
Collapse
|
21
|
Jiao D, Li Z, Li Z, Shui S, Han XW. Flat detector cone beam CT-guided nephrostomy using virtual navigation in patients with iatrogenic ureteral injury. Radiol Med 2017; 122:557-563. [PMID: 28332142 DOI: 10.1007/s11547-017-0751-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 03/06/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the feasibility of flat detector cone beam computed tomography (CBCT)-guided nephrostomy using virtual navigation in patients with iatrogenic ureteral injury. MATERIALS AND METHODS A retrospective review of percutaneous nephrostomy (PN) revealed the use of CBCT with 3D virtual navigation guidance in 42 procedures (40 patients) for patients with iatrogenic ureteral injury. All procedures were shown as second-line interventions after failed ultrasound-guided nephrostomy. Data on technical success rate, procedure time, puncture performance, radiation exposure, complications, and clinical success were collected. RESULTS The technical success rate was 95.2% (40/42). The mean puncture performance score was 4.4 ± 1.0, and the procedure time was 25.2 ± 3.1 min, resulting in a mean effective exposure dose of 5.9 ± 2.3 mSv. There were no serious complications. During the mean follow-up periods of 11.4 months (range 6-19), clinical success rates following drainage were 72.5% (29/40), and ten cases (25%) had secondary surgical treatments. CONCLUSION CBCT with 3D virtual navigation is a feasible technique for PN with reasonable exposure dose and can serve as a second-line intervention after failed ultrasound guidance.
Collapse
Affiliation(s)
- Dechao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Zongming Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Zhiguo Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Shaofeng Shui
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xin-Wei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China.
| |
Collapse
|
22
|
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.
Collapse
Affiliation(s)
- Daniel Chung
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - James Briggs
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | | | | |
Collapse
|
23
|
Patil SB, Guru N, Kundargi VS, Patil BS, Patil N, Ranka K. Posthysterectomy ureteric injuries: Presentation and outcome of management. Urol Ann 2017; 9:4-8. [PMID: 28216920 PMCID: PMC5308036 DOI: 10.4103/0974-7796.198838] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: The purpose of the study was to evaluate the presentation and management of posthysterectomy ureteral injuries. Patients and Methods: Fourteen patients with ureteric injuries after hysterectomy for benign diseases were evaluated. The diagnosis was done based on clinical presentation, intravenous urogram, computed tomography, cystoscopy, and retrograde pyelogram (RGP) depending on the clinical situation. Results: Sixteen iatrogenic ureteric injuries in 14 patients over a 2-year period were evaluated. Hysterectomy was the cause of injury in all the cases, 12 abdominal and 2 were vaginal. Two patients presented with anuria, one had ureteric, and bladder injury with hemoperitoneum underwent emergency laparotomy and bilateral ureteral reimplantation. Another patient underwent RGP followed by stenting on the right side, left side unable to put stent so percutaneous nephrostomy (PCN) was done followed by antegrade stenting later. Two patients presented with septicemia and pyonephrosis were managed initially with PCN followed by balloon dilatation and JJ stenting. RGP and retrograde stenting was done in seven of the remaining ten patients and ureteric reimplantation in three patients. Conclusion: Patient with ureteric injury should be evaluated and intervened at the earliest. Patients presenting early, within 2 weeks after hysterectomy have higher chances of success with endourological procedures, obviating the need for open surgery.
Collapse
Affiliation(s)
- S B Patil
- Department of Urology, Shri B. M. Patil Medical College and Hospital Research Centre, Bijapur, Karnataka, India
| | - Nilesh Guru
- Department of Urology, Shri B. M. Patil Medical College and Hospital Research Centre, Bijapur, Karnataka, India
| | - V S Kundargi
- Department of Urology, Shri B. M. Patil Medical College and Hospital Research Centre, Bijapur, Karnataka, India
| | - B S Patil
- Department of Urology, Shri B. M. Patil Medical College and Hospital Research Centre, Bijapur, Karnataka, India
| | - Nikhil Patil
- Department of Urology, Shri B. M. Patil Medical College and Hospital Research Centre, Bijapur, Karnataka, India
| | - Kshitiz Ranka
- Department of Urology, Shri B. M. Patil Medical College and Hospital Research Centre, Bijapur, Karnataka, India
| |
Collapse
|
24
|
|
25
|
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]
|
26
|
Kim TH, Kim CJ, Kim TJ, Lee YY, Choi CH, Lee JW, Bae DS, Kim BG. Retroperitoneal Approach in Single-Port Laparoscopic Hysterectomy. JSLS 2016; 20:JSLS.2016.00001. [PMID: 27186067 PMCID: PMC4867503 DOI: 10.4293/jsls.2016.00001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: In single-port laparoscopic hysterectomy(SP-LH), ligation of the uterine artery is a fundamental step. We analyzed the effectiveness and safety of 2 different surgical approaches to ligate the uterine artery in SP-LH for women with uterine myomas or adenomyosis. Methods: A single surgeon (TJ Kim) performed 36 retroperitoneal single-port laparoscopic hysterectomies (SP-rH) from September 1st 2012 to April 30th 2013. We compared these cases with 36 cases of conventional single-port laparoscopic abdominal hysterectomy (SP-aH) performed by the same surgeon from November 1st 2011 to July 31th 2012 (historic control). In the SP-rH cases, the retroperitoneal space was developed to identify the uterine artery; then, it was ligated where it originates from the internal iliac artery. Results: Estimated blood loss (EBL) was decreased in the SP-rH group compared with the SP-aH group (100 mL vs 200 mL; P = .023). The median total operative time was shorter in the SP-rH group (75 minutes vs 93 minutes; P < .05). The operative time of the Scope I phase, including ligation of the utero-ovarian (or infundibulopelvic) ligament, round ligament, uterine artery, and detachment of the bladder, was longer in the SP-rH group compared with that in the SP-aH group (26.0 minutes vs 24 minutes; P = .043). However, the operative time of the Scope II phase, including detachment of the uterosacral-cardinal ligament, vaginal cutting, and uterus removal, was shorter in the SP-rH group (19.5 minutes vs 30 minutes; P < .05). Operative complications were not significantly different between the groups (P = .374). Conclusion: Although SP-rH may be considered technically difficult, it can be performed safely and efficiently with surgical outcomes comparable to those of SP-aH.
Collapse
Affiliation(s)
- Tae-Hyun Kim
- Department of Obstetrics and Gynecology, Konyang University Hospital, Daejon, Korea
| | - Chul Jung Kim
- Department of Obstetrics and Gynecology, Konyang University Hospital, Daejon, Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo-Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk-Soo Bae
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
27
|
Tayeb ME, Mellon MJ, Lingeman JE. Simultaneous percutaneous nephrolithotomy and early endoscopic ureteric realignment for iatrogenic ureteropelvic junction avulsion during ureteroscopy. Can Urol Assoc J 2016; 9:E882-5. [PMID: 26834898 DOI: 10.5489/cuaj.2830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We present a case report of successful management of ureteropelvice junction avulsion during ureteroscopy successfully managed with simultaneous percutaneous nephrolithotomy and early endoscopic ureteral realignment.
Collapse
Affiliation(s)
- Marawan El Tayeb
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
| | - Matthew J Mellon
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
| | - James E Lingeman
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
| |
Collapse
|
28
|
El Abd AS, El-Abd SA, El-Enen MA, Tawfik AM, Soliman MG, Abo-Farha M, Gamasy AENE, El-Sharaby M, El-Gamal S. Immediate and late management of iatrogenic ureteric injuries: 28 years of experience. Arab J Urol 2015; 13:250-7. [PMID: 26609443 PMCID: PMC4656805 DOI: 10.1016/j.aju.2015.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 07/09/2015] [Accepted: 07/13/2015] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the long-term results after managing intraoperative and late-diagnosed cases of iatrogenic ureteric injury (IUI), treated endoscopically or by open surgery. Patients and methods Patients immediately diagnosed with IUI were managed under the same anaesthetic, while those referred late had a radiological assessment of the site of injury, and endoscopic management. Open surgical procedures were used only for the failed cases with previous diversion. Results In all, 98 patients who were followed had IUI after gynaecological, abdominopelvic and ureteroscopic procedures in 60.2%, 14.3% and 25.5%, respectively. The 27 patients diagnosed during surgery were managed immediately, while in the late-referred 71 patients ureteroscopic ureteric realignment with stenting was successful in 26 (36.6%). Complex open reconstruction with re-implantation or ureteric substitution, using bladder-tube or intestinal-loop procedures, was used in 27 (60%), 16 (35.5%) and two (4.5%) patients of the late group, respectively. A long-term radiological follow-up with a mean (range) of 46.6 (24.5–144) months showed recurrent obstruction in 16 (16.3%) patients managed endoscopically and reflux in six (8.3%) patients. Three renal units only (3%) were lost in the late-presenting patients. Conclusion Patients managed immediately had better long-term results. More than a third of the late-diagnosed patients were successfully managed endoscopically with minimal morbidity. Open reconstruction by an experienced urologist who can perform a complex substitutional procedure was mandatory to preserve renal units in the long-term.
Collapse
Affiliation(s)
- Ahmed S. El Abd
- Corresponding author at: 3 Mosafa Maher Street, Tanta, Egypt. Tel.: +20 1001833152.
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Liourdi D, Kallidonis P, Kyriazis I, Tsamandas A, Karnabatidis D, Kitrou P, Spyroulias GA, Kostopoulou ON, Marousis K, Kalpaxis DL, Goumenos DS, Liatsikos E. Evaluation of the Distribution of Paclitaxel by Immunohistochemistry and Nuclear Magnetic Resonance Spectroscopy After the Application of a Drug-Eluting Balloon in the Porcine Ureter. J Endourol 2015; 29:580-9. [DOI: 10.1089/end.2014.0683] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Despoina Liourdi
- Department of Internal Medicine, General Hospital of Aeghio, Aeghio, Greece
| | | | - Iason Kyriazis
- Department of Urology, University of Patras, Patras, Greece
| | | | | | | | | | | | - Kostas Marousis
- Department of Biochemistry, University of Patras, Patras, Greece
| | | | | | | |
Collapse
|
30
|
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
| |
Collapse
|
31
|
Postoperative ureteral leak treated using a silicone-covered nitinol stent. Int Neurourol J 2015; 19:47-50. [PMID: 25833481 PMCID: PMC4386481 DOI: 10.5213/inj.2015.19.1.47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/03/2015] [Indexed: 11/12/2022] Open
Abstract
Ureteral fistula is a serious complication of abdomino-pelvic surgeries, often resulting in poor outcomes owing to lack of proper treatment. We report the case of a 49-year-old woman who underwent placement of a silicone-covered ureteral occlusion stent in her right ureter for the management of ureteral leakage after pelvic surgery. A ureterogram obtained 18 months following the stent placement confirmed that there was no stent migration or additional urine leakage. We propose that the silicone-covered ureteral occlusion stent is practical, fast, and safe for the management of ureteral leakage.
Collapse
|
32
|
Kim CH, Ro JH, Jung H. Modified laparoscopic intravesical nonrefluxing ureteral reimplantation with psoas hitch using a submucosal tunneling. J Exerc Rehabil 2015; 10:378-82. [PMID: 25610823 PMCID: PMC4294441 DOI: 10.12965/jer.140174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 12/17/2014] [Indexed: 11/22/2022] Open
Abstract
We aimed to study the safety and efficacy of the cystoscopy-assisted nonrefluxing ureteral reimplantation technique using submucosal tunneling during laparoscopic ureteroneocystostomy (UNC) with a psoas hitch in patients with distal ureter stricture after gynecologic surgery. We reviewed six female patients who underwent gynecological surgeries. All patients showed persistent postoperative distal ureter stricture or obstruction. These patients underwent laparoscopic nonrefluxing UNC with a psoas hitch using a submucosal tunneling technique combined with cystoscopy at our institute. They had corrective surgery at an average of 13.3 weeks after ureteral injury. The short-term success was confirmed either by voiding cystourethrography (VCU) or by diuretic isotope renal scan (MAG-3) conducted 3 months after the operation. None of the patients showed evidence of postoperative stricture at the reimplanted site and reflux on either MAG-3 renal scan or VCU. None of the patients showed major or minor complications during follow-up. It is safe and feasible to perform the laparoscopic nonrefluxing UNC with a psoas hitch using a submucosal tunneling technique combined with cystoscopy for ureteral stricture.
Collapse
Affiliation(s)
- Chang-Hee Kim
- Department of Urology, Gachon University Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Joo Hwan Ro
- Department of Urology, Gachon University Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Han Jung
- Department of Urology, Gachon University Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| |
Collapse
|
33
|
Review of the current management of upper urinary tract injuries by the EAU Trauma Guidelines Panel. Eur Urol 2015; 67:930-6. [PMID: 25578621 DOI: 10.1016/j.eururo.2014.12.034] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/18/2014] [Indexed: 11/22/2022]
Abstract
CONTEXT The most recent European Association of Urology (EAU) guidelines on urological trauma were published in 2014. OBJECTIVE To present a summary of the 2014 version of the EAU guidelines on upper urinary tract injuries with the emphasis upon diagnosis and treatment. EVIDENCE ACQUISITION The EAU trauma guidelines panel reviewed literature by a Medline search on upper urinary tract injuries; publication dates up to December 2013 were accepted. The focus was on newer publications and reviews, although older key references could be included. EVIDENCE SYNTHESIS A full version of the guidelines is available in print and online. Blunt trauma is the main cause of renal injuries. The preferred diagnostic modality of renal trauma is computed tomography (CT) scan. Conservative management is the best approach in stable patients. Angiography and selective embolisation are the first-line treatments. Surgical exploration is primarily for the control of haemorrhage (which may necessitate nephrectomy) and renal salvage. Urinary extravasation is managed with endourologic or percutaneous techniques. Complications may require additional imaging or interventions. Follow-up is focused on renal function and blood pressure. Penetrating trauma is the main cause of noniatrogenic ureteral injuries. The diagnosis is often made by CT scanning or at laparotomy, and the mainstay of treatment is open repair. The type of repair depends upon the severity and location of the injury. CONCLUSIONS Renal injuries are best managed conservatively or with minimally invasive techniques. Preservation of renal units is feasible in most cases. This review, performed by the EAU trauma guidelines panel, summarises the current management of upper urinary tract injuries. PATIENT SUMMARY Patients with trauma benefit from being accurately diagnosed and treated appropriately, according to the nature and severity of their injury.
Collapse
|
34
|
Abstract
Iatrogenic injury to the ureter is a potentially devastating complication of modern surgery. The ureters are most often injured in gynecologic, colorectal, and vascular pelvic surgery. There is also potential for considerable ureteral injury during endoscopic procedures for ureteric pathology such as tumor or lithiasis. While maneuvers such as perioperative stenting have been touted as a means to avoid ureteral injury, these techniques have not been adopted universally, and the available literature does not make a case for their routine use. Distal ureteral injuries are best managed with ureteroneocystostomy with or without a vesico-psoas hitch. Mid-ureteral and proximal ureteral injuries can potentially be managed with ureteroureterostomy. If the distal segment is unsuitable for anastomosis then a number of techniques are available for repair including a Boari tubularized bladder flap, transureteroureterostomy, or renal autotransplantation. In rare cases renal autotransplantation or ureteral substitution with gastrointestinal segments may be warranted to re-establish urinary tract continuity. Laparoscopic and minimally invasive techniques have been employed to remedy iatrogenic ureteral injuries.
Collapse
Affiliation(s)
- Frank N Burks
- Fellow, Trauma and Reconstructive Urology, Detroit Receiving Hospital and Clinical Associate Professor, Michigan State University School of Osteopathic Medicine, Royal Oak, MI, USA
| | - Richard A Santucci
- Clinical Professor, Michigan State University School of Osteopathic Medicine, Harper Professional Building, Suite 1017, 4160 John R., Detroit, MI 48201, USA
| |
Collapse
|
35
|
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.
Collapse
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
| | | |
Collapse
|
36
|
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.
Collapse
|
37
|
Kachrilas S, Bourdoumis A, Karaolides T, Nikitopoulou S, Papadopoulos G, Buchholz N, Masood J. Current status of minimally invasive endoscopic management of ureteric strictures. Ther Adv Urol 2013; 5:354-65. [PMID: 24294293 DOI: 10.1177/1756287213505671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Endourological techniques are used more often nowadays in the treatment of ureteric strictures of various etiologies. Advances in technology have provided new tools to the armamentarium of the endoscopic urological surgeon. Numerous studies exist that investigate the efficiency and safety of each of the therapeutic modalities available. In this review, we attempt to demonstrate the available and contemporary evidence supporting each minimally invasive modality in the management of ureteric strictures.
Collapse
Affiliation(s)
- Stefanos Kachrilas
- Endourology and Stone Services, Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | | | | | | | | | | |
Collapse
|
38
|
Endoscopic realignment in the management of complete transected ureter. Int Urol Nephrol 2013; 46:335-40. [DOI: 10.1007/s11255-013-0535-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/29/2013] [Indexed: 11/25/2022]
|
39
|
|
40
|
Summerton DJ, Kitrey ND, Lumen N, Serafetinidis E, Djakovic N. EAU Guidelines on Iatrogenic Trauma. Eur Urol 2012; 62:628-39. [DOI: 10.1016/j.eururo.2012.05.058] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 05/28/2012] [Indexed: 11/29/2022]
|
41
|
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.
Collapse
Affiliation(s)
- Jeong Hyun Park
- Department of Urology, Korea Cancer Center Hospital, Seoul, Korea
| | | | | | | |
Collapse
|
42
|
Buffi N, Cestari A, Lughezzani G, Bellinzoni P, Sangalli M, Scapaticci E, Zanoni M, Annino F, Larcher A, Lazzeri M, Rigatti P, Guazzoni G. Robot-Assisted Uretero-Ureterostomy for Iatrogenic Lumbar and Iliac Ureteral Stricture: Technical Details and Preliminary Clinical Results. Eur Urol 2011; 60:1221-5. [DOI: 10.1016/j.eururo.2011.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 03/10/2011] [Indexed: 11/26/2022]
|