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Xiao J, Liu T, Zhu Q, Qiu L, Ge J, Chen H. Clinical efficacy of ureteroscopy-assisted laparoscopic ureteroplasty in the treatment of ureteral stricture after pelvic surgery. Int Urol Nephrol 2024:10.1007/s11255-024-04115-4. [PMID: 38872017 DOI: 10.1007/s11255-024-04115-4] [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: 04/29/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE This study is to investigate the safety and efficacy of ureteroscope-assisted laparoscopic ureteroplasty in treating ureteral stricture after pelvic surgery. METHODS A retrospective analysis of the clinical data of 95 patients treated for ureteral stricture at Ganzhou People's Hospital from June 2017 to March 2023 after pelvic surgery. In this group, 49 patients underwent ureteroscope and laparoscopic ureteroplasty under lithotomy position. The control group consisted of 46 patients who underwent simple laparoscopic ureteroplasty in a supine position. Postoperative data from both groups were collected and compared, including operation time, amount of blood loss during surgery, postoperative hospital stay, incidence of complications, success rate of ureteroplasty, and effectiveness of the operation. RESULTS The success rate of end-to-end ureteral anastomosis in the observation group was 93.88%, and the operation effectiveness rate was 100%. The success rate in the control group was 78.26% and the operation effectiveness rate was 89.1%.The average operation time and intraoperative blood loss in the observation group were (121.3 ± 44.6) min and (137.5 ± 34.2) ml, respectively, while in the control group they were (151.2 ± 52.3) min and (165.6 ± 45.8) ml, the difference were statistically significant (P < 0.05). The incidence of perioperative complications in the observation group was 2%, significantly lower than that in the control group (19.6%) (P < 0.05). CONCLUSION Ureteroscope-assisted laparoscopic ureteroplasty for ureteral stricture after pelvic surgery has the advantages of shortened operation time, increased success rate, and reduced incidence of complications, making it an optional surgical scheme in clinical practice.
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Affiliation(s)
- Jiansheng Xiao
- Department of Urology, Ganzhou People's Hospital, Jiangxi Medical College, Nanchang University, Ganzhou, Jiangxi, China
| | - Tairong Liu
- Department of Urology, Ganzhou People's Hospital, Jiangxi Medical College, Nanchang University, Ganzhou, Jiangxi, China
| | - Qiuhua Zhu
- Department of Operating Room, Ganzhou People's Hospital, Jiangxi Medical College, Nanchang University, Ganzhou, Jiangxi, China
| | - Liling Qiu
- Department of Operating Room, Ganzhou People's Hospital, Jiangxi Medical College, Nanchang University, Ganzhou, Jiangxi, China
| | - Jiaqi Ge
- Department of Urology, Ganzhou People's Hospital, Jiangxi Medical College, Nanchang University, Ganzhou, Jiangxi, China
| | - Hua Chen
- Department of Urology, Ganzhou People's Hospital, Jiangxi Medical College, Nanchang University, Ganzhou, Jiangxi, China.
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Ahmed F, Al-Wageeh S, Badheeb M, Altam A, Alsharif A. Iatrogenic Ureteral and Colonic Injuries During Emergency Cesarean Section: A Lesson Learned from a Surgical Catastrophe - A Case Report. Int Med Case Rep J 2023; 16:251-256. [PMID: 37143965 PMCID: PMC10153445 DOI: 10.2147/imcrj.s407241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/27/2023] [Indexed: 05/06/2023] Open
Abstract
Introduction Iatrogenic concomitant ureteral and colonic injury in emergency cesarean section (C-section) is an exceedingly rare, yet, catastrophic complication and has not been reported to our knowledge. Case Report A 30-year-old woman presented with decreased urination for 2 days after a C-section. Ultrasonography showed severe left hydronephrosis and moderate abdominal free fluid. A ureteroscopy revealed a total occlusion of the left ureter, and subsequently, a ureteroneocystostomy was performed. Two days later, the patient was complicated with abdominal distension that necessitated re-exploration. The exploration revealed colonic injury (rectosigmoid), peritonitis, endometritis, and ureteral anastomosis disruption. A colostomy, repair of colonic injury, hysterectomy, and ureterocutaneous diversion were performed. The patient's hospital stay was complicated, with stomal retraction requiring operative revision and wound dehiscence, which was treated conservatively. After 6 months, the colostomy was closed, and the ureter was anastomosed via the Boari-flap procedure. Conclusion Injuries to the urinary and gastrointestinal tracts are serious complications of a cesarean section; concurrent involvement is exceedingly rare; however, delayed recognition and intervention can worsen the prognosis.
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Affiliation(s)
- Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen
- Correspondence: Faisal Ahmed, Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen, Tel/Fax +967 4428950, Email
| | - Saleh Al-Wageeh
- Department of General Surgery, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen
| | - Mohamed Badheeb
- Department of Internal Medicine, Faculty of Medicine, Hadhramout University, Hadhramout, Yemen
| | - Abdulfattah Altam
- Department of General Surgery, School of Medicine, 21 September University, Sana’a, Yemen
| | - Afaf Alsharif
- Department of Gynecology, School of Medicine, Jeblah University for Medical and Health Sciences, Ibb, Yemen
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Risk Factors for Urological Complications Associated with Caesarean Section—A Case-Control Study. Medicina (B Aires) 2022; 58:medicina58010123. [PMID: 35056431 PMCID: PMC8779572 DOI: 10.3390/medicina58010123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives: Acute urologic complications, including bladder and/or ureteric injury, are rare but known events occurring at the time of caesarean section (CS). Delayed or inadequate management is associated with increased morbidity and poor long-term outcomes. We conducted this study to identify the risk factors for urologic injuries at CS in order to inform obstetricians and patients of the risks and allow management planning to mitigate these risks. Materials and Methods: We reviewed all cases of urological injuries that occurred at CS surgeries in a tertiary university centre over a period of four years, from January 2016 to December 2019. To assess the risk factors of urologic injuries, a case-control study of women undergoing caesarean delivery was designed, matched 1:3 to randomly selected women who had an uncomplicated CS. Electronic medical records and operative reports were reviewed for socio-demographic and clinical information. Descriptive and univariate analyses were used to characterize the study population and identify the risk factors for urologic complications. Results: There were 36 patients with urologic complications out of 14,340 CS patients, with an incidence of 0.25%. The patients in the case group were older, had a lower gestational age at time of delivery and their newborns had a lower birth weight. Prior CS was more prevalent among the study group (88.2 vs. 66.7%), as was the incidence of placenta accreta and central praevia. In comparison with the control group, the intraoperative blood loss was higher in the case group, although there was no difference among the two groups regarding the type of surgery (emergency vs. elective), uterine rupture, or other obstetrical indications for CS. Prior CS and caesarean hysterectomy were risk factors for urologic injuries at CS. Conclusions: The major risk factor for urological injuries at the time of CS surgery is prior CS. Among patients with previous CS, those who undergo caesarean hysterectomy for placenta previa central and placenta accreta are at higher risk of surgical haemostasis and complex urologic injuries involving the bladder and the ureters.
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Urology Coverage for Obstetric and Gynecological Operative Procedures Should Go Hand in Hand in a Hospital Setting. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:883-884. [PMID: 34872148 PMCID: PMC10183893 DOI: 10.1055/s-0041-1739165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Nayak AL, Breau R, Hickling D, Pascali D, Clancy A, Mallick R, Chen I. Risk Factors for Urologic Injury in Women Undergoing Hysterectomy for Benign Indication. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:247-254. [PMID: 34648958 DOI: 10.1016/j.jogc.2021.09.020] [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: 06/27/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate risk factors associated with urologic injury in women undergoing hysterectomy for benign indication. METHODS A retrospective cohort study for the period of 2011-2018 was conducted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Women without urologic injury were compared with women with injury. A pre-specified multivariable logistic regression model, controlling for key patient demographic factors and intraoperative variables, was used to assess for surgical factors associated with urologic injury. RESULTS Among 262 117 women who underwent hysterectomy for benign indication, 1539 (0.6%) sustained urologic injury. On average, patients with urologic injury were younger, had lower body mass index (BMI), and more frequently underwent a transabdominal surgical approach. Patients who underwent total hysterectomy had increased odds of urologic injury than those who underwent subtotal hysterectomy (adjusted OR [aOR] 1.49; 95% confidence interval [CI] 1.21-1.84). Patients with class III obesity had lower odds of injury than patients with normal BMI (aOR 0.64; 95% CI 0.51-0.80). For risk of urologic injury, an interaction was observed between surgical approach and surgical indication. Abdominal compared with laparoscopic approach was associated with urologic injury for women with endometriosis (aOR 2.98; 95% CI 1.99-4.47), pelvic pain (aOR 3.51; 95% CI 1.74-7.08), menstrual disorders (aOR 4.33; 95% CI 1.68-11.1), and fibroids (aOR 2.28; 95% CI 1.72-3.03). Vaginal compared with laparoscopic approach was associated with increased odds of injury for women with menstrual disorders (aOR 7.62; 95% CI 1.37-42.5). CONCLUSION While the risk of urologic injury during hysterectomy for benign indication is low, the risk is dependent on patient disease factors and surgical approach.
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Affiliation(s)
| | - Rodney Breau
- Faculty of Medicine, University of Ottawa, Ottawa, ON; The Ottawa Hospital Research Institute, Ottawa, ON; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON
| | - Duane Hickling
- Faculty of Medicine, University of Ottawa, Ottawa, ON; The Ottawa Hospital Research Institute, Ottawa, ON; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON
| | - Dante Pascali
- Faculty of Medicine, University of Ottawa, Ottawa, ON; Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, ON
| | - Aisling Clancy
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, ON
| | | | - Innie Chen
- The Ottawa Hospital Research Institute, Ottawa, ON; Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, ON.
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Feng D, Tang Y, Yang Y, Wei X, Han P, Wei W. Does prophylactic ureteral catheter placement offer any advantage for laparoscopic gynecological surgery? A urologist' perspective from a systematic review and meta-analysis. Transl Androl Urol 2020; 9:2262-2269. [PMID: 33209691 PMCID: PMC7658113 DOI: 10.21037/tau-20-674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Our aim is to assess the efficacy of prophylactic ureteral catheter placement on patients undergoing laparoscopic gynecological surgery. We searched the electronic database including PubMed, Cochrane Library, Embase, Web of Science, WANFANG and CNKI in January 2020 to identify possible studies without languages limitations. A manual search was also conducted. The trials that compared catheterized group (CG) to non-catheterized group (NCG) were included. This meta-analysis was accomplished by RevMan5 (version 5.3). Initial search yield 997 studies and 5 randomized control trials were included in the final meta-analysis. Pooling data of five studies showed that patients in the CG had a lower risk of ureteral injury than those in NCG (RR: 0.44, 95% CI: 0.20–0.97, P=0.04) without significant between-study heterogeneity (P=0.23, I2=29%). The pooled data analysis showed a statistically significant difference in favor of prophylactic ureter catheter placement (MD: −40.51, 95% CI: −58.65 to −22.36, P<0.0001). Random-effects model meta-analysis found that patients in the CG experienced higher EBL compared to NCG (SMD: −5.78, 95% CI: −10.51 to −1.04, P=0.02). There was no statistically significant difference between CG group and NCG group (P=0.23) with regard to LOS. Current evidence indicates that prophylactic ureteral catheter placement has the advantages of reducing ureteral injury, shortening the operative time, and reducing the amount of bleeding. It might serve as a routine preoperative preparation choice for laparoscopic gynecological surgery, especially with pelvic adhesion. Further large volume, multicenter well-designed trials are warranted before making the final clinical guidelines.
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Affiliation(s)
- Dechao Feng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yin Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yubo Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Han
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Wuran Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Iwamoto G, Kawahara T, Takeshima T, Ninomiya S, Takamoto D, Mochizuki T, Kuroda S, Yao M, Uemura H. Successful treatment of ureteral stricture after total hysterectomy: An antegrade ureteroscopic approach facilitates the insertion of a guidewire for endoscopic dilation. IJU Case Rep 2019; 2:140-142. [PMID: 32743395 PMCID: PMC7292084 DOI: 10.1002/iju5.12061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/20/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Iatrogenic ureteral injury is sometimes seen in daily clinical practice, and gynecological surgery carries the highest risk of ureteral injury among iatrogenic surgical ureteral injury. Case presentation A 61‐year‐old woman was referred to our department for right ureteral stricture and hydronephrosis after total hysterectomy. We initially attempted ureteral stenting, but hydronephrosis redeveloped 1 month after ureteral stent removal. We performed ureteroscopy via an antegrade approach and successfully incised and dilated the ureter. Conclusion We encountered a case of severe ureteral stenosis after total hysterectomy that was successfully treated endoscopically using ureteroscopy via an antegrade approach.
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Affiliation(s)
- Genta Iwamoto
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Takashi Kawahara
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Teppei Takeshima
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Sahoko Ninomiya
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Daiji Takamoto
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Taku Mochizuki
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Shinnosuke Kuroda
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Masahiro Yao
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Hiroji Uemura
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
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[THREE CASES OF IATROGENIC URETERAL INJURY ASSOCIATED WITH TOTAL LAPAROSCOPIC HYSTERECTOMY]. Nihon Hinyokika Gakkai Zasshi 2019; 110:138-143. [PMID: 32307383 DOI: 10.5980/jpnjurol.110.138] [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: 11/08/2022]
Abstract
We report three cases of iatrogenic ureteral injury associated with total laparoscopic hysterectomy. Case 1 was a 50-year-old woman. She underwent total laparoscopic hysterectomy (TLH) for myoma uteri. Postoperatively, a blood test revealed renal dysfunction, and ultrasonography (US) revealed left hydronephrosis. She was referred to our department on the next day of TLH. Computed tomography (CT) revealed left hydronephrosis. Retrograde pyelography (RP) was tried, but the ureteral catheter could not be inserted into the left ureteral orifice. An operation was performed on the second day after THL. The left ureter was ligated near the ureterovesical junction, and so uretero-ureterostomy was conducted. Case 2 was a 38-year-old woman. She underwent TLH for myoma uteri. Postoperatively, she complained of abdominal fullness and diarrhea. A blood test revealed renal dysfunction and US revealed left hydronephrosis on the ninth day after THL. She was referred to our department next day. CT revealed left hydronephrosis and ascitis. RP revealed extravasation of contrast medium from the left ureter. She was diagnosed with left ureteral injury accompanied by extravasation of urine into the intraperitoneal space. Uretero-cystoneostomy was performed. Case 3 was a 45-year-old woman. She underwent TLH for myoma uteri. Postoperatively, a blood test revealed renal dysfunction, and US revealed left hydronephrosis. She was referred to our department on the fifth day after TLH. CT revealed left hdronephrosis and ureteral obstruction of the left lower ureter. An operation was performed under laparoscopy, cystoscopy, and fluoroscopy on that day and the left lower ureter was kinked by threads. Cutting of the threads was performed under laparoscopy. After thread cutting, the kink of the ureter was improved and ureteral stent could be indwelled between the renal pelvis and bladder. After 1 month, the ureteral stent was removed and left hydronephrosis disappeared.
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Abstract
PURPOSE OF REVIEW This article provides an update on the use of cystoscopy at the time of prolapse and incontinence surgery. RECENT FINDINGS Iatrogenic lower urinary tract injury is a known complication of antiincontinence procedures and surgical repair of pelvic organ prolapse. Intraoperative cystoscopy improves detection of lower urinary tract injuries in women undergoing pelvic floor surgery. The pelvic surgeon has a number of agents available to aid in the cystoscopic visualization of ureteral efflux. When injuries of the urinary tract are identified and treated intraoperatively, there is decreased morbidity, lower healthcare costs, and a lower risk of litigation than when detection is delayed. Therefore, many organizations, including the American College of Obstetricians and Gynecologists (ACOG), the American Urogynecologic Society (AUGS), and the American Urological Association (AUA) recommend cystoscopy at the time of pelvic floor surgery. SUMMARY Cystoscopy should be universally employed at the time of prolapse and incontinence surgery, except in instances of isolated repair of the posterior compartment.
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