1
|
Ridha F, Latifa M, Ines R, Maamar H, Salem B. [Ureteral injuries complicating gynecologic surgery]. Pan Afr Med J 2018; 30:145. [PMID: 30374391 PMCID: PMC6201629 DOI: 10.11604/pamj.2018.30.145.15470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/24/2018] [Indexed: 11/11/2022] Open
Abstract
Iatrogenic ureteral lesions may occur after any pelvic surgery. They are severe and can affect renal function and even vital prognosis. This study aimed to determine the clinical aspects and the therapeutic approaches of this injury. We conducted a retrospective study of six patients with iatrogenic ureteral lesions following gynecologic or obstetric surgery whose data were collected in the Department of Urology in Kairouan on a period of 4 years (2012-2016). The average age of our patients was 46 years. They were all multiparous. Clinical symptoms were variable depending on the type of lesion. Intravenous urography is very useful for diagnosis. It was performed in 4 cases showing abnormalities. Treatment was based on the insertion of a catheter in one case and on 5 uretero-vesical reimplantations. The postoperative course was marked by a nephrectomy. Iatrogenic ureteral lesions have become a rarity. They are correlated with the degree of medicalization in the country. Gynecological and obstetric surgery is the main cause of iatrogenic ureteral lesions. Prognosis is conditioned by early diagnosis and the anatomic condition of the ureter.
Collapse
Affiliation(s)
- Fatnassi Ridha
- Service de Gynécologie, CHU Ibn El Jazzar, Kairouan, Tunisie
| | - Merzougui Latifa
- Service d'Hygiène Hospitalière, CHU Ibn El Jazzar, Kairouan, Tunisie
| | - Rebhi Ines
- Service de Gynécologie, CHU Ibn El Jazzar, Kairouan, Tunisie
| | - Hajji Maamar
- Service de Gynécologie, CHU Ibn El Jazzar, Kairouan, Tunisie
| | - Braiek Salem
- Service d'Urologie, CHU Ibn El Jazzar, Kairouan, Tunisie
| |
Collapse
|
2
|
Soria J, Guandalino M, Vedrine N, Pereira B, Guy L. [Results of conservative surgical management of ureteral injuries]. Prog Urol 2017; 28:120-127. [PMID: 29162380 DOI: 10.1016/j.purol.2017.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/13/2017] [Accepted: 10/20/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The ureter is a retroperitoneal organ. Ureteral injuries are rare, with a prevalence of 0.083% of surgical interventions over 10 years. The objective of this study was to evaluate the surgical management of ureteric injuries according to the time of discovery, their size and their location. We also evaluated the results of this management on the renal repercussion as well as the predictive factors of the severity of the ureteric injuries. MATERIAL AND METHODS This was a monocentric retrospective study carried out on the basis of a systematic review of the CHU surgery files. RESULTS The average follow-up was 30 months. The average hospital stay was 8 days. Thirty-four patients (73.9%) underwent initial endoscopic management by attempting a double J probe. Only 20 patients received this double J probe and only 11 patients (55%) did not recidivate the ureteral injury with a median duration of maintenance of the double J probe of 90 days (28-240). Thirty-five patients received open surgical management (76.1%). We found 57% ureterovesical reimplantations (n=20), corresponding to pelvic ureteral injuries (n=32). We also found 20% of nephrectomies. No patient had recurrence of the ureteral injury. Eight patients had secondary dilatation of the pyelocalicious cavities (28.57%). The success of surgical treatment was therefore 57%. CONCLUSION The management of surgically treated ureter injuries provides good results but remains relatively diversified due to the different lesion levels. It was effective in 57% of cases including nephrectomies as failure of treatment. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- J Soria
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - M Guandalino
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - N Vedrine
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - B Pereira
- Service de biostatistique, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - L Guy
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| |
Collapse
|
3
|
Guandalino M, Vedrine N, Galonnier F, Pereira B, Boiteux JP, Guy L. [Endoscopic management of postoperative ureteral wound. Retrospective unicentric study from October 2003 to June 2014]. Prog Urol 2016; 26:360-6. [PMID: 27209220 DOI: 10.1016/j.purol.2016.04.001] [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: 11/29/2015] [Revised: 03/24/2016] [Accepted: 04/01/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ureteral wounds are rare with an incidence of 0.5 to 1% of pelvic surgeries. Their supports and their prognosis remain dependant of the period of support and the level of ureteral lesion. The importance of early treatment reduces morbidity and improves patient prognosis. METHODS A retrospective study from October 2003 to June 2014 was performed in a university hospital using a systematic chart review of patients' urology, digestive surgery, vascular surgery and gynecology. RESULTS Forty-six wounds were found in 43 patients. The majority of the ureteral wound was found at the pelvic ureter, i.e. 69.6% of the study population (n=32). The main cause was gynecological surgery (n=25). In the simple wound group, endoscopic treatment was effective in nearly 90% of cases (n=6). In the other two groups, the efficacy was only 30% and imposed a surgical treatment as second-line. CONCLUSION The management is based primarily on early detection or intraoperative, and on a correct initial knowledge of the location and size of the lesion. Endoscopic treatment can in most cases treated with a simple and minimally invasive operation an ureteral wound with nearly 90% success rate. In more complex wounds, endoscopy remains a step in the management with about 30% success rate in our study. LEVEL OF EVIDENCE 5.
Collapse
Affiliation(s)
- M Guandalino
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - N Vedrine
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - F Galonnier
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - B Pereira
- Département de bio-statistique, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - J P Boiteux
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - L Guy
- Service d'urologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| |
Collapse
|
4
|
Bryk DJ, Zhao LC. Guideline of guidelines: a review of urological trauma guidelines. BJU Int 2015; 117:226-34. [PMID: 25600513 DOI: 10.1111/bju.13040] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To review the guidelines released in the last decade by several organisations for the optimal evaluation and management of genitourinary injuries (renal, ureteric, bladder, urethral and genital). METHODS This is a review of the genitourinary trauma guidelines from the European Association of Urology (EAU) and the American Urological Association (AUA), and renal trauma guidelines from the Société Internationale d'Urologie (SIU). RESULTS Most recommendations are guided by the American Association for the Surgery of Trauma (AAST) organ injury severity system. Grade A evidence is rare in genitourinary trauma, and most recommendations are based on Grade B or C evidence. The findings of the most recent urological trauma guidelines are summarised. All guidelines recommend conservative management for low-grade injuries. The major difference is for haemodynamically stable patients who have high-grade renal trauma; the SIU guidelines recommend exploratory laparotomy, the EAU guidelines recommend renal exploration only if the injury is vascular, and the AUA guidelines recommend initial conservative management. CONCLUSION There is generally consensus among the three guidelines. Recommendations are based on observational or retrospective studies, as well as clinical principles and expert opinions. Multi-institutional collaborative research can improve the quality of evidence and direct more effective evaluation and management of urological trauma.
Collapse
Affiliation(s)
- Darren J Bryk
- Department of Urology, NYU School of Medicine, New York, NY, USA
| | - Lee C Zhao
- Department of Urology, NYU School of Medicine, New York, NY, USA
| |
Collapse
|
5
|
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]
|
6
|
Klap J, Phé V, Chartier-Kastler E, Mozer P, Bitker MO, Rouprêt M. [Aetiology and management of iatrogenic injury of the ureter: a review]. Prog Urol 2012; 22:913-9. [PMID: 23102013 DOI: 10.1016/j.purol.2012.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 05/16/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Ureteric injuries (IU) are common complications occurring during abdomino-pelvic surgical procedures. Our aim was to review risk factors, treatment and methods of prevention of these iatrogenic UI. MATERIAL AND METHODS A literature review in English and French by Medline(®) was performed using the keywords: ureter; iatrogenic; injury; ureteroscopy; morbidity and endoscopy. RESULTS The analysis of the epidemiology of IU shows that the first two causes are gynecological and urological surgery. In 80% of cases, the pelvic ureter was concerned. Mechanisms of injury were essentially ligation, section and ischemia by altering the ureteral vasculature. The main risk factors found were pelvic inflammation (endometriosis, radiation…) and the occurrence of bleeding during surgery. In the presence of risk factors, placing a double J stent or a CT may be useful preoperatively. The choice of reparation technique depended on the location of the PU, the circumstances of the occurrence and experience of the surgical team. CONCLUSION Pelvic surgery is a provider of iatrogenic PU. Knowledge of the management of PU once occurred must be mastered before carrying out any risk surgery.
Collapse
Affiliation(s)
- J Klap
- Service d'urologie, université Paris VI, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | | |
Collapse
|
7
|
The diagnosis and treatment of iatrogenic ureteral and bladder injury caused by traditional gynaecology and obstetrics operation. Arch Gynecol Obstet 2011; 285:763-5. [DOI: 10.1007/s00404-011-2075-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 08/29/2011] [Indexed: 10/17/2022]
|
8
|
Abstract
CONTEXT These guidelines were prepared on behalf of the European Association of Urology (EAU) to assist urologists in the management of traumatic urethral injuries. OBJECTIVE To determine the optimal evaluation and management of urethral injuries by review of the world's literature on the subject. EVIDENCE ACQUISITION A working group of experts on Urological Trauma was convened to review and summarize the literature concerning the diagnosis and treatment of genitourinary trauma, including urethral trauma. The Urological Trauma guidelines have been based on a review of the literature identified using on-line searches of MEDLINE and other source documents published before 2009. A critical assessment of the findings was made, not involving a formal appraisal of the data. There were few high-powered, randomized, controlled trials in this area and considerable available data was provided by retrospective studies. The Working Group recognizes this limitation. EVIDENCE SYNTHESIS The full text of these guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article comprises the abridged version of a section of the Urological Trauma guidelines. CONCLUSIONS Updated and critically reviewed Guidelines on Urethral Trauma are presented. The aim of these guidelines is to provide support to the practicing urologist since urethral injuries carry substantial morbidity. The diversity of urethral injuries, associated injuries, the timing and availability of treatment options as well as their relative rarity contribute to the controversies in the management of urethral trauma.
Collapse
|
9
|
|
10
|
Abstract
PURPOSE OF REVIEW Urethrovaginal fistulae are a rare condition. It is a conceptual mistake to consider urethrovaginal fistulae to be synonymous with vesicovaginal fistulae. Urethrovaginal fistulae are a different entity requiring special attention and treatment. Due to the wide variety and individuality of the clinical manifestations of these injuries, it is practically impossible to find and create common guidelines for treatment. Taking into account the difficulty of urethrovaginal fistula treatment, we decided to conduct a review of the current literature on this subject. RECENT FINDINGS Due to advances in obstetric care, urologists in the developed world encounter urethrovaginal fistulae rarely, and many of the fistulae seen are secondary to vaginal surgery. Surgical treatment procedures include direct primary anatomical repair and interpositional tissue restorations, mainly by Martius flap. Successful direct anatomical repair alone may result in the development of stress urinary incontinence or obstructed voiding in up to 50% of patients. Synthetic tape should be removed during fistula repair, which may lead to the resumption of stress incontinence. SUMMARY Prevention of urethrovaginal fistulae can be achieved through both improvements in obstetric care and adequate training in vaginal surgery. The success of any surgical treatment depends on careful patient selection, and assumes knowledge of all possible treatment options. Potential work needs to be directed towards the application of the newest molecular technologies.
Collapse
|
11
|
|
12
|
Trottmann M, Tritschler S, Graser A, Strittmatter F, Becker A, Haseke N, Stief CG. Verletzungen des Nierenbeckens und des Ureters. Urologe A 2007; 46:927-34; quiz 935-6. [PMID: 17628782 DOI: 10.1007/s00120-007-1373-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
About 5% of injuries of the urinary tract affect the renal pelvis and ureter and constitute a severe complication. Around 75% of these injuries are iatrogenic and only about 25% are caused by blunt abdominal trauma or perforation. To avoid complications and improve prognosis, immediate diagnosis and therapy are essential. The diagnostic accuracy of preoperative studies is low, therefore frequently injuries are detected during explorative laparotomy. The management of upper urinary tract lesions depends on severity and localization, whereas the ultimate ambition should always be the preservation of the kidney. As a basic rule, ureteral stenting is mostly sufficient for small lesions, and only larger injuries require open reconstructive techniques. Longitudinal studies document a high degree of functional reconstitution if adequate and immediate treatment is carried out.
Collapse
Affiliation(s)
- M Trottmann
- Urologische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München-Grosshadern, 81377, München.
| | | | | | | | | | | | | |
Collapse
|
13
|
Brandes S, Coburn M, Armenakas N, McAninch J. Diagnosis and management of ureteric injury: an evidence-based analysis. BJU Int 2004; 94:277-89. [PMID: 15291852 DOI: 10.1111/j.1464-410x.2004.04978.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Steven Brandes
- Department of Surgery (Urology), School of Medicine, Washington University Medical Center, 4960 Children's Place, St. Louis, MO 63110, USA.
| | | | | | | |
Collapse
|
14
|
Rafique M, Arif MH. Management of iatrogenic ureteric injuries associated with gynecological surgery. Int Urol Nephrol 2003; 34:31-5. [PMID: 12549636 DOI: 10.1023/a:1021320409583] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This retrospective study defines the presentation and management of iatrogenic ureteric injuries consequent upon gynecological surgery in a teaching hospital in Punjab, Pakistan. PATIENTS AND METHODS 18 patients with median age 35 years (range 18-80 years) with iatrogenic ureteric injuries associated with gynecological surgery were referred to the department of urology at Nishtar Hospital Multan Pakistan. Main presenting symptoms were urinary incontinence, loin pain and anuria. Median time since injury and presentation was 3 weeks (range 1 day to 7 years). In 16 (88%) patients injury resulted from abdominal hysterectomy. Other causes included ovarian cystectomy (one patient) and vaginal hysterectomy (one patient). 11 (61%) patients had ureterovaginal fistula, 5 (28%) patients had complete unilateral ureteric obstruction and 2 (11%) patients had bilateral ureteric obstruction and anuria. In 11 patients with ureterovaginal fistula ureteroneocystostomy was performed. In five patients with unilateral ureteric obstruction, one had end to end anastomosis of ureter, three had ureteroneocystostomy only and one had ureteroneocystostomy and psoas hitch done. Two had anuria secondary to bilateral ureteric obstruction. In one of these patients Boari flap and ureteroneocystostomy was carried out. The second patient had deligation of catgut sutures on ipsilateral side and ureteroneocystostomy on the contra-lateral side. RESULTS In 17 patients no major complication occurred. One patient who had deligation of catgut sutures, the distal ureter sloughed and re-exploration and ureteroneocystostomy was performed. Renal salvage was achieved in all cases. CONCLUSION Open surgical procedures for repair of iatrogenic ureteric injuries are associated with good outcome. Strategies to prevent these injuries include adequate surgical training and meticulous surgical techniques.
Collapse
|