scholarly journals A retrospective study of urological injuries during obstetrics and gynecological procedures

2020 ◽  
Vol 9 (7) ◽  
pp. 2746
Author(s):  
Sunil Kumar Samal ◽  
Setu Rathod ◽  
Kalaivani Thangavel
Keyword(s):  
Clinical Presentation ◽  
Tertiary Care ◽  
Bladder Injury ◽  
Obstetrics And Gynecology ◽  
Management Option ◽  
Ureteric Injury ◽  
Obstetrics And Gynaecology ◽  
Bladder Injuries ◽  
High Degree ◽  
Urological Injuries

Background: Urological injury in obstetrics and gynaecology are not uncommon because there is a close anatomical association between reproductive and urological system. The objective of this study was to find out the incidence and types of urological injuries in obstetric and gynaecological procedures, clinical presentation and various management option in a tertiary care hospital.Methods: The study was a retrospective analysis of all obstetric and gynecological surgeries over a period of 6 years from January 2014 to December 2019. Cases with the documented urological injuries during these procedures were analyzed further.Results: Total 8595 patients had undergone different obstetrics and gynecology procedures, out of which 5429 were obstetrics and 3166 were gynecology surgeries.  Out of 3166 of gynecology procedures, there were 16 cases (0.5%) of bladder injuries and one case (0.03%) of ureteric injury. Out of 5429 cases of obstetric procedures there were 11 (0.2%) cases of bladder injury and one case (0.01%) of ureteric injury.Conclusions: The incidence urological injuries during obstetrics and gynecological procedures are rare but the morbidity associated these are significant. Therefor surgeons should be more cautious and high degree of suspicion can help in early diagnosis and avoid the sequel.

scholarly journals Urinary Tract Injury at Gynecological Surgery: Results from a Tertiary-Care Institution

2017 ◽  
Vol 23 (3) ◽  
pp. 143
Author(s):  
Tayfun Toptaş ◽  
Aysel Uysal ◽  
Selim Karataş ◽  
Işın Üreyen ◽  
Onur Erol
Keyword(s):  
Urinary Tract ◽  
Tertiary Care ◽  
High Volume ◽  
Urethral Injury ◽  
Annual Number ◽  
Bladder Injury ◽  
Ureteric Injury ◽  
Urinary Tract Injury ◽  
Bladder Injuries ◽  
Ureteric Injuries

<p><strong>Objective:</strong> To identify clinical features of urinary tract injuries detected during or after gynecologic surgeries, with a specific focus on incidence and role of surgeon and surgical route on urinary injury.</p><p><strong>Study design:</strong> The institutional database from January 2009 to January 2017 was reviewed with respect to gynecologic (non-obstetric) surgeries and urinary injuries.</p><p><strong>Results:</strong> A total of 8719 gynecologic surgeries were identified. Of these, 46 (0.52%) were found to be complicated with a bladder (N=34, 0.38%), ureteral (N=11, 0.12%) and/or urethral injury (N=1, 0.01%). Bladder injuries occurred mostly at the superior part of the bladder, while ureteric injuries at the most distal part of the ureter. Ureteric injuries were mostly delayed (81.8% vs. 5.9%, P&lt;0.001) and were more related to thermal injury than bladder injuries (45.5% vs. 8.8%, P=0.029). Among all surgical procedures, radical hysterectomy had the highest incidence for the ureteric injury (8.53%), while Burch colposuspension via minimally invasive route had the highest incidence for the bladder injury (16.6%). Cumulative incidence of urinary injury significantly differed according to the surgical route preferred (P=0.032), with the vaginal surgeries were associated with the highest incidence (0.96%). However, there was no such a difference in injury rates between the low-volume (0.55%) and high-volume (0.52%) surgeons (P=0.328)</p><p><strong>Conclusion:</strong> Overall incidence of lower urinary tract injury at gynecologic surgeries is low, does not differ according to annual number of surgeries performed, but increases with the vaginal surgeries.</p>

scholarly journals Indications and Complications of Obstetric Hysterectomy in a Tertiary Care Hospital of Lahore

2018 ◽  
Vol 24 (S) ◽  
pp. 831-835
Author(s):  
Shamila Ijaz Munir ◽  
Riffat Iqbal ◽  
Shamsa Humayun ◽  
Saima Chaudhary
Keyword(s):  
Tertiary Care Hospital ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Haemorrhagic Shock ◽  
Bladder Injury ◽  
Care Hospital ◽  
Maternal Complications ◽  
Ureteric Injury ◽  
Normal Delivery ◽  
Risk Patients

OBJECTIVES: To find out the frequency of obstetric hysterectomy, its indications and associated maternal complications in a tertiary care hospital of Lahore, Pakistan. METHODOLOGY: This is a retrospective observational descriptive study. It was done in Department of Obstetrics and Gynaecology of a Tertiary Care Hospital, Lahore from Feb 2015 to Jan 2016. All the records of patients, who had undergone hysterectomy, within 24 hours of normal delivery or caesarean section, were reviewed. The details of age, parity, booking status, indication and Complications of operation were recorded on a predesigned proforma. RESULTS: The total deliveries during the period were 5, 754. Obstetric hysterectomy was performed in 26 patients. This gives frequency of the emergency obstetric hysterectomy in our unit to be 4.5/1000 births. The major indication was previous caesarean sections with placenta previa and/or accreta in 17 cases (65.38%), followed by massive postpartum haemorrhage due to uterineatony in 4 cases (15.38%), uterine rupture in 3(11.5%) and abruption placenta in 2 (7.6%). Most common complication was haemorrhagic shock seen in 14 patients. There were 5 cases of bladder injury, 2 Ureteric injury and 2 vault hematomas. Maternal deaths occurred in 3 cases. CONCLUSION: Emergency obstetric hysterectomy is increasing with increased frequency of caesarean sections and placenta previa and accreta. Antenatal booking of high risk patients, timely referral to tertiary care hospital with good surgical expertise and ICU care can reduce morbidity and mortality in such cases.

scholarly journals A study of male friendly approach in obstetrics and gynaecology outpatient department

2017 ◽  
Vol 6 (3) ◽  
pp. 1113 ◽  
Author(s):  
Jalpa K. Bhatt ◽  
Malini R. Desai
Keyword(s):  
Decision Making ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Outpatient Department ◽  
Obstetrics And Gynecology ◽  
Reproductive Disorders ◽  
Obstetrics And Gynaecology ◽  
Paramedical Staff ◽  
Female Relative ◽  
Novel Concept

Background: Involvement of male relative in management of female reproductive disorders is low in many countries including India. Active participation of male relatives by establishing male friendly approach in Obstetrics and Gynecology (OBGY) outpatient department is a novel concept. This study explores the perceptions of male relatives accompanying the patients regarding male friendly approach which constitutes attitude of medical and paramedical staff towards them, involvement of male relatives in counseling and their role in decision making in obstetrics and gynecology outpatient department.Methods: This prospective study was carried out over three months in Obstetrics-Gynecology outpatient department of a tertiary care teaching hospital. Male relatives accompanying the patient were enrolled in the study. The participants were allowed to remain present at the time of history taking and post examination counseling. They were also asked to be part of the decision making whenever required. Feedback from the male relatives was obtained using a questionnaire.Results: Out of 450 patients attending the OBGY Outpatient Department (OPD) during the three months study period 100 were accompanied by male relatives. Participation in decision making was the commonest reason for accompanying the patient (36%). All the male relatives involved in this study were satisfied with the approach of doctor and paramedical staff and 85% were willing to accompany their female relative at every visit.Conclusions: Making health services for women more male friendly would increase participation of male relative in healthcare of female reproductive disorders. This can improve women’s health and eventually reduce maternal and neonatal morbidity and mortality.

scholarly journals High Riding Prostate: Epidemiology of Genitourinary Injury in Motorcyclists from a UK Register of over 12,000 Victims

2020 ◽  
Vol 14 (2) ◽  
pp. 105-112
Author(s):  
Basil F. Moss ◽  
Catherine E. Moss ◽  
Patrick Dervin ◽  
Thomas Lawrence ◽  
Sophie Jones ◽  
...  
Keyword(s):  
Pelvic Fracture ◽  
Road Traffic ◽  
Significant Proportion ◽  
Body Armor ◽  
Research Network ◽  
Renal Trauma ◽  
Urethral Injury ◽  
Bladder Injury ◽  
Bladder Injuries ◽  
Urological Injuries

Background: The mechanism of motorcycle accidents (high speeds, pelvis behind fuel tank) may predispose to genitourinary injury (GUI) but the epidemiology is poorly understood. Previous studies have assessed GUI patterns in cyclists, and road traffic accident victims in general, but no study has analyzed GUI patterns in a large cohort of motorcyclists. Objectives: We aimed to better understand patterns of urological injuries among motorcyclists admitted to hospital. We aimed to determine any relationship between pelvic fracture and GUI patterns or severity. Methods: The Trauma Audit Research Network was reviewed to identify motorcyclists admitted between January 2012 and December 2016 (n = 12,374). Cases were divided into riders (n = 11,926) and pillion passengers (n = 448), and the data analyzed to identify urological injuries and their associations. The associations between pelvic fracture and other injury types were tested for significance by one- and two-way χ2. Results: GUI was identified in 6%. Renal trauma was the most common GUI among riders (4%) and pillions (2%). There was no statistically significant relationship between grade of renal trauma and presence of pelvic fracture. Urethral injury occurred in 0.2% of riders and passengers, and bladder injury in 0.4% of riders and 0.7% of pillions. Urethral and bladder injuries were positively associated with pelvic fracture, which was present in 81 and 92%, respectively. Testicular trauma occurred in 0.4% of riders and 0.7% of pillions. Body armor was recorded in 3% of casualties with urological trauma, and 3% overall. Conclusions: A significant proportion of motorcyclists brought to accident and emergency department have GUI, most commonly renal trauma. Pelvic fracture is more common in pillion passengers than riders, and associated with urethral and bladder injuries, but it does not predict severity of renal trauma. External genital injuries are rare, but we recommend examination in the tertiary survey, as consequences of missed injury are severe. Further research is needed to explore protective effects of motorcyclist clothing.

scholarly journals Ectopic pregnancy in a tertiary care centre of Jharkhand, India

2019 ◽  
Vol 8 (8) ◽  
pp. 2969
Author(s):  
Meetali Parashar ◽  
Meena Mehta
Keyword(s):  
Ectopic Pregnancy ◽  
Clinical Presentation ◽  
Previous History ◽  
First Trimester ◽  
Near Miss ◽  
Obstetrics And Gynaecology ◽  
Maternal Morbidity And Mortality ◽  
History Of ◽  
Β Hcg ◽  
A Prospective Study

Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions:Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions: Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.

scholarly journals A national study of choanal atresia in tertiary care centers in Canada – part I: clinical presentation

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Josee Paradis ◽  
Agnieszka Dzioba ◽  
Hamdy El-Hakim ◽  
Paul Hong ◽  
Frederick K. Kozak ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Choanal Atresia ◽  
Case Series ◽  
Retrospective Chart Review ◽  
National Study ◽  
Feeding Difficulties ◽  
Presenting Symptoms ◽  
Tertiary Care Centers

Abstract Background To evaluate the clinical presentation of choanal atresia (CA) in tertiary centers across Canada. Methods Multi-centre case series involving six tertiary care pediatric hospitals across Canada. Retrospective chart review of patients born between 1980 and 2010 diagnosed with CA at a participating center. Results The health charts of 215 patients (59.6% female) with CA were reviewed and included in this study. The mean age of patients at time of CA presentation was 0.4 months (range 0.1 to 7.2 months) for bilateral CA and 37.8 months (range 0.1 to 164.1 months) for unilateral cases. The most common presenting symptoms for bilateral CA in decreasing order were respiratory distress (96.4%), feeding difficulties (68.2%), and rhinorrhea (65.5%), and for unilateral cases in decreasing order were rhinorrhea (92.0%), feeding difficulties (24.7%), and respiratory distress (18.0%). For the majority of patients (73.2%), the obstruction comprised mixed bony and membranous tissue, with only 10.5% presenting with a purely membranous obstruction. Familial history of CA was confirmed in only 3.3% of cases. One half of patients with CA presented with one or more associated anomalies and 30.6% had a syndrome. Conclusions The present investigation is the first national multi-institutional study evaluating the clinical presentation of CA over three decades. The present cohort of CA patients presented with a breadth of co-morbidities with highly variable presentations, with bilateral cases being more severely affected than unilateral cases. Further investigation into hereditary linkages to CA development is warranted. Graphical abstract

scholarly journals Placenta Previa Accreta Spectrum: Cesarean Hysterectomy

2021 ◽  
Author(s):  
Satoru Takeda ◽  
Jun Takeda ◽  
Yoshihiko Murayama
Keyword(s):  
Blood Flow ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Autologous Blood ◽  
Vaginal Wall ◽  
Balloon Occlusion ◽  
Bladder Injury ◽  
Ureteric Injury ◽  
Cardinal Ligament ◽  
Cesarean Hysterectomy

AbstractWhen cesarean hysterectomy is scheduled in cases of placenta previa accreta/increta/percreta, it is necessary that the departments of obstetrics, anesthesiology, blood transfusion, urology, and radiology hold a preoperative conference to assure full preparation for the surgery. A ureteral stent inserted just before cesarean section serves as a marker. A uterine incision should be made at a site free of placental contact. The presence/absence of bladder invasion by villi, adhesions, and the degree of vascularization greatly influence the amount of bleeding, and bleeding control is a key point. For prevention of massive hemorrhage, methods of blood flow blockage, such as balloon occlusion catheterization of the aorta or common iliac artery, should be considered. Stored autologous blood and Cell Saver should be prepared. When hysterectomy is performed with the placenta left in situ, handling of the elongated cardinal ligament, ureteric injury, and bladder injury are important issues because the lower uterine segment is enlarged with the placenta. If blood flow is not blocked, separation of the bladder at the area of placenta percreta should be performed as the last step, to reduce bleeding (Pelosi's method). At this time, after handling of the cardinal ligament, bladder separation can be performed more safely if the posterior vaginal wall is incised and exposed first.In cases of placenta accreta or partial placenta accreta/increta/percreta, a diagnosis of morbidly adherent placenta may not be obtained until separation of the placenta is performed. If bleeding from the placental separation surface cannot be controlled, total hysterectomy should be performed without hesitation.

scholarly journals The Incidence, Management, and Outcome of Penetrating Bladder Injuries in Civilians Resultant from Armed Conflict in Baghdad 2005-2006

2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Firas G. Petros ◽  
Richard A. Santucci ◽  
Naimet K. Al-Saigh
Keyword(s):  
Primary Repair ◽  
Bladder Injury ◽  
Associated Injuries ◽  
Bladder Drainage ◽  
Young Males ◽  
Iraqi War ◽  
Missed Injury ◽  
War Zone ◽  
Civilian Trauma ◽  
Bladder Injuries

The purpose of this paper is to review the diagnosis, treatment, and outcomes of penetrating bladder injuries suffered by civilians in the Iraqi war zone.Materials and Methods.All civilian trauma cases received alive at Al-Yarmouk Teaching Hospital from January 2005 to August 2006 were reviewed for the presence of bladder injury.Results.533 cases of penetrating abdominal trauma were identified, of which 177 (33%) involved the genitourinary (GU) system and 64 (12%) involved the bladder. Most (70%) were young males, and most (55%) had grade IV injuries. Associated injuries occurred in 63/64 (98%) of patients. 3 patients had missed bladder injuries, and all of these had complications related to their missed injury. Bladder-related complications occurred in 11% of cases, and mortality in 13%, all due to extravesical injuries.Conclusions.Penetrating bladder injury among civilians in Baghdad war zone resulted in 64 cases in 18 months. The initial detection rate is very high (98%), and after primary repair, lasting complications are rare. Morbidities from missed injuries were severe hematuria and vesicorectal fistula. However, (3%) of vesicorectal fistulae healed spontaneously with prolonged bladder drainage. Associated injuries are the rule in penetrating bladder injury patients, and must be diligently investigated and treated.

EVALUATION OF GRADING OF BREAST MALIGNANCIES ON FINE NEEDLE ASPIRATES AND COMPARISON OF TWO GRADING SYSTEMS AT A TERTIARY CARE HOSPITAL OF NORTH INDIA

2021 ◽  
pp. 192-194
Author(s):  
Shazia Bashir ◽  
Aamir Hussain ◽  
Irm Yasmeen
Keyword(s):  
Tertiary Care ◽  
North India ◽  
Care Hospital ◽  
Breast Cancers ◽  
Cross Sectional ◽  
Fine Needle Aspirates ◽  
Grading Systems ◽  
Grade Ii ◽  
Grade 3 ◽  
High Degree

AIM: To evaluate and compare the cytograding of breast cancers using Robinson's and Moriquand's grading methods MATERIAL AND METHODS: This study was a cross-sectional retrospective study conducted over a period of three years w. e .f October 2014 to October 2017 and includes diagnosed or highly suspicious malignant cases of breast carcinoma. Slides were retrieved from the cytology section of Department of Pathology, GMC Jammu. A total of 84 cases of breast cancers were studied and grading was done using Robinson's and Mouriquand's methods and the two grading methods were then compared. RESULTS: Out of 84 cases of breast cancers , on using Robinson's grading method , 11 cases [13.10%] were graded as grade 1, 65 cases [77.38%] were graded as grade 2 and 8 cases [9.52%] cases as grade 3. 9 (10.71%) cases are graded as Grade I by Mouriquand's method with score less than 5. 68(80.95%) cases were graded as Grade II with score 5-9 and 7 (8.33%) were graded ad Grade III with score ≥10. On doing comparison between the two cytograding methods, we found a high degree of concordance between the two systems [ 96.42% ] . The relationship observed between the scores obtained by the two methods was also seen to be highly signicant. CONCLUSION: There is possibility of comprehensive cytograding of breast cancers by using the two different methods proposed by Robinson's and Moriquand's but out of the two methods inspite of a high degree of concordance between the two methods , the grading system of Robinson's because of its more objective set of criterias and easy reproducibility has been found to be easier and better.

Study on Maternal and Neonatal Outcome of women undergoing Caesarean Section using Nice Classification in a Tertiary Care Hospital in Rural Area of Central India - An Observational Prospective Study

2021 ◽  
Vol 17 ◽  
Author(s):  
Shuchi M. Jain ◽  
Ketki. Thool ◽  
Manish A. Jain ◽  
Poonam V. Shivkumar
Keyword(s):  
Caesarean Section ◽  
Prospective Study ◽  
Neonatal Outcome ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Central India ◽  
Neonatal Morbidity ◽  
Bladder Injury ◽  
Care Hospital ◽  
Chi Square

Background : Caesarean section is often perceived to be safer than vaginal delivery for mothers and neonates, and thus has become increasingly common around the globe. However, it may actually be detrimental to maternal and neonatal health while consuming valuable resources. Objective : The objective of this study was to categorize the caesarean sections performed in our rural institute into various categories using NICE classification and to study the maternal and neonatal outcome in them. Method : This was a prospective study of all women who underwent caesarean section over a period of 18 months. Data was retrieved from the files of women for morbiditiy and mortality in mothers and babies. Data was entered in MS excel sheet and analyzed with percentages and chi square test using SPSS ver.17. Results: Caesarean section rate (CSR) was 36.88%. All CS were classified into four categories based on urgency as per NICE guidelines. There were 22.62% women in Category I, 38.61% in category II, 28.37% in category III and 10.40% in Category IV. Adhesions, extension of angle, lacerations in lower segment, scar dehiscence, atonic PPH and bladder injury were noted in (12.83%), 11.81%, 6.83%, 4.08% , 1.53% and 0.08% CS respectively. Caesarean hysterectomy was done in 0.24% cases. Postoperative morbidity was febrile morbidity (11.93%), postdural puncture headache (13.85%), paralytic ileus (11.49%), wound infection (8.83%), ARDS (0.70%), sepsis (0.78%), pulmonary edema (0.47%) and pulmonary embolism (0.03%). Maternal mortality was 0.03%. Neonates born were 2577 (29 were twin deliveries). 82.46% neonates were healthy, 16.80% had morbidities and 0.74% were still born. Apgar score of less than 7 was in 10%. 16.80% neonates were admitted in NICU during their hospital stay. Neonatal mortality was 1.47%. Conclusion : Intraoperative and post-operative complication were more in caesarean sections of category I and II as compared to category III and category IV. Neonatal morbidity, mortality and admissions to NICU were more in caesarean sections of category I and II as compared to category III and category IV. Thus though caesarean section is an emergency lifesaving procedure for mother and baby it may prove detrimental to their health.

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