Ureteric injuries during cancer surgery presentation and management over a 20-year

Background: Iatrogenic ureteral injury rare 0.3-1.5%. complication of abdominopelvic cancer surgery. We aimed to study the risk and management of ureteral injury among cancer patients. Methods: Diagnosis can be achieved retrograde pyelography, ureteroscopy, CT, or intravenous urography. Results: Years 2000 to 2020, 2904 patients in the Department of Surgical oncology, Assuit University, and 47 ureteral injury cases were identified. (1.62), 4/231 cervical cancer, 9/611 ovarian cancer and 7/462 endometrial cancer.,11/818 colon cancer,12/620 rectal cancer, 1/11 prostatic cancer, 3/151 retroperitoneal sarcoma. 34% (radical abdominal hysterectomy 8.5% Wertheim hysterectomies 4%), colorectal surgery colectomy 25.5%, low anterior resection2.1% in radical prostatectomy and 6.4% in retroperitoneal tumor, intraoperative diagnosis 48.9%, 8.5% in laparoscopic surgeries, the distal third (53.2%),23.4% catheterization, complete transection 31.9%; partial 14.9%, ligation 8.5%, laceration in 19.1%, resection. 8.5%; and devascularization in 17%. Fever in 14.9%, abdominal or flank pain in 38.5%. Oligura in 6.4%, ileus in 19.3%, urinary leakage (vaginally or via abdominal wound) in 10.6% rise creatinine in 10.6%, hydronephrosis in 6.4%, urinoma in 27.7%, extravasation in 8.5% asymptomatic in 4.3%, 40.4% percutaneous nephrostomy. 19.1%primary repair Ureteroneocystostomy in (17%) Boari flap in 12.7%, Psoas hitch in 23.4% stenting in 14.9%, 8.5% ileum interposition, anastomosis to contralateral ureter in 4.3%, ureteral stricture 6.4%, ureterovaginal fistulas in 10.6%, acute renal failure 2.1%, peritonitis 4.3, urinary tract infection in 14.9%.Conclusions: The recognition and immediate repair of ureteral injuries early during the same procedure was highly desirable and to avoid a second operation.

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Early Repair of Pelvic and Abdominal Nonurological Surgery-Induced Iatrogenic Ureteral Injuries in Three Distinct Waiting-for-Repair Time Periods

The American Surgeon ◽

10.1177/000313481207801137 ◽

2012 ◽

Vol 78 (11) ◽

pp. 1270-1275 ◽

Cited By ~ 3

Author(s):

Jingquan Li ◽

Zhaoyan Chen ◽

Qingguo Zhu ◽

Yakun Zhao ◽

Haiping Wang ◽

...

Keyword(s):

Surgical Repair ◽

Ureteral Injury ◽

Therapeutic Effects ◽

Middle Segment ◽

Boari Flap ◽

Urological Surgery ◽

Ureteral Injuries ◽

Psoas Hitch ◽

Time Periods ◽

Iatrogenic Ureteral Injury

The purpose of this study was to explore whether the time from pelvic and abdominal non-urological surgery-induced iatrogenic ureteral injuries to repair associates with outcomes. We retrospectively reviewed 81 cases of pelvic and abdominal nonurological surgery-induced iatrogenic ureteral injuries occurring in 78 patients treated at our hospital from January 2000 to December 2009. Time between injury and surgical repair, operative times, and incidence of complications were compared. Lower ureteral segment injuries occurred in 66 cases, middle segment injuries in 13, and upper segment injuries in two. Surgical repair methods included 36 ureteroneocystostomies, 17 ureteroneocystostomy with psoas hitch, 14 ureteroureterostomies/ureteral end-to-end anastomosis, and 10 ureteroneocystostomies with a Boari flap. Immediate intraoperative repair was carried out in 23 cases. In 42 cases, repair was delayed as a result of late identification and performed within 1 month after surgery. In 10 cases, repair was performed 3 months after surgery. No significant differences were observed in operative times of repair surgeries or incidence of postoperative complications. Delayed discovery of iatrogenic ureteral injury can still result in good therapeutic effects if the surgical repair is done within 1 month after injury under the premise that no serious urinary tract infection is present and the patient can tolerate surgery.

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Late diagnosis of ureteral injury from anterior lumbar spine interbody fusion surgery: Case report and literature review

Urologia Journal ◽

10.1177/03915603211030230 ◽

2021 ◽

pp. 039156032110302

Author(s):

Filippo Migliorini ◽

Nicola de Maria ◽

Alessandro Tafuri ◽

Antonio Benito Porcaro ◽

Emanuele Rubilotta ◽

...

Keyword(s):

Interbody Fusion ◽

Rare Event ◽

Ureteral Injury ◽

Direct Access ◽

Lumbar Pain ◽

Disc Disease ◽

Management Options ◽

Boari Flap ◽

Ureteral Injuries ◽

Ureteral Lesion

Background: Anterior Lumbosacral Interbody Fusion (ALIF) is a type of back surgery with the advantages of direct access to the spinal interbody space and the potential lessening morbidity related to posterior approaches. Purpose: To describe a rare case of left ureteral lesion from ALIF surgery diagnosed 4 months after the procedure. Case description: A 37-year-old Caucasian man with a long history of painful post-traumatic spondylolisthesis and degenerative L5-S1 disc disease underwent a retroperitoneal anterior L5-S1 discectomy, insertion of an interbody tantallium cage, and placement of a pyramid titanium plate fixed with screws. Four months later, due to recurrent left lumbar pain and mild renal failure, a CT scan was performed showing left hydronephrosis with a homolateral urinoma of 17 cm in diameter. A left nephrostomy was placed and the nephrostography detected a filiform leakage at L5-S1 level in communication with the urinoma. The patient underwent laparoscopic urinoma drainage, distal left ureterectomy, and Casati-Boari flap ureterocystoneostomy with ureteral double J stent placement. The stent was held for six weeks and, 1 month later, the control ultrasound scan was negative for hydronephrosis, the creatinine level had normalized and the patient was asymptomatic. Conclusion: Ureteral lesion from ALIF surgery is a very rare event. Spinal surgeons should be more awareness regarding the susceptibility of ureteral injuries along with the clinical presentation, diagnostic work-up, and management options for this kind of complication.

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Isolated Proximal Ureteric Injury after a Penetrating Stab Wound to Lumbar Region

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/46613.14707 ◽

2021 ◽

Author(s):

Manav Goyal ◽

G Sivasankar ◽

J Sivabalan

Keyword(s):

Tertiary Care ◽

Ureteral Injury ◽

Ureteral Stricture ◽

Lumbar Region ◽

Care Hospital ◽

Ureteric Injury ◽

Contrast Enhanced ◽

Ureteral Injuries ◽

High Index Of Suspicion ◽

Enhanced Computed Tomography

Urological injuries fall far behind other abdominal injuries when it comes to involvement during trauma. Amongst urological trauma, ureteral injuries account for 1-2.5%. An isolated ureteral injury is infrequently encountered because of a safe retroperitoneal location and a smaller diameter of the ureter as compared to other organs. A high index of suspicion is needed as a delayed or missed diagnosis of penetrating ureteral trauma or an unrecognised and mismanaged ureteral injury can lead to significant complications, including formation of urinoma, abscess, ureteral stricture or urinary fistula, and potential loss of the ipsilateral kidney. The present case report is of a 35-year-old male who presented to the Emergency Department of tertiary care hospital with a stab injury in left lumbar region and was diagnosed with isolated ureteral injury on Contrast Enhanced Computed Tomography (CECT). Without much delay, ureteroscopy was done, a double J stent was placed and ureteroureterostomy was performed.

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WHAT IS THE EFFECT OF SMALL SIZE URETERAL ACCESS SHEAT ON URETERAL STRICTURE DURING RETROGRADE INTRARENAL SURGERY?: A ONE-YEAR FOLLOW-UP.

10.22541/au.161494245.53004135/v1 ◽

2021 ◽

Author(s):

özer güzel ◽

Melih Balci ◽

Altug Tuncel ◽

Ahmet Asfuroglu ◽

Can Aykanat ◽

...

Keyword(s):

Major Complication ◽

Ureteral Injury ◽

Late Complications ◽

Flexible Ureteroscopy ◽

First Year ◽

Ureteral Stricture ◽

Retrograde Intrarenal Surgery ◽

Ureteral Access Sheath ◽

Access Sheath ◽

Ureteral Injuries

Aim: To analyze the ureteral injury and incidence of ureteral stricture in a series of patients who underwent retrograde intrarenal surgery with using smallest ureteral access sheath. Materials and Methods: Between September 2016 and March 2019, 154 consecutive retrograde intrarenal surgery procedures with adjunctive use of an ureteral access sheath for kidney stone were prospectively included the study. A 9.5/11.5-F ureteral access sheath was used during procedures. The patients were evaluated in terms of intraoperative postoperative and late complications. Ureteral injuries after retrograde intrarenal surgery were assessed visually with flexible and semirigid ureterorenoscope. All patients were evaluated by computed tomographic urography in the first year after treatment for detection of ureteral stricture. Results: The mean age of the patients was 47±15 (12-81) years. Of the patients, 86 were male and 68 were female. Mean stone size was 17.1±8 (7-40) mm and mean operative time was 56±23 (30-120) minutes. Overall 79.9% of patients had evidence of injury to the ureter wall. Non-significant lesion (grade 0) was seen in 39.0% of patients. Grade 1 lesions were assigned in 40.9% of patients. There were no grade 2 and higher lesions detected. A total of 5 patients (3.2%) had minor complications. Urinary sepsis developed as a major complication in 3 patients (1.9%). No ureteral stricture was detected in the patients at first year control. Conclusions: The results of our series indicate that the 9.5/11.5-F ureteral access sheath is safe for routine use to facilitate flexible ureteroscopy and there was no long-term adverse effect.

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Improving Global Surgical Oncology Benchmarks: Defining the Unmet Need for Cancer Surgery in Ghana

World Journal of Surgery ◽

10.1007/s00268-021-06197-y ◽

2021 ◽

Author(s):

Cameron E. Gaskill ◽

Adam Gyedu ◽

Barclay Stewart ◽

Robert Quansah ◽

Peter Donkor ◽

...

Keyword(s):

Unmet Need ◽

Surgical Oncology ◽

Cancer Surgery

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Management of Ureteral Strictures and Ureteropelvic Junction Obstruction

10.2310/uro.11005 ◽

2019 ◽

Author(s):

Sean McAdams ◽

Haidar Abdul-Muhsin ◽

Mitchell R. Humphreys

Keyword(s):

Ureteropelvic Junction Obstruction ◽

Ureteropelvic Junction ◽

Ureteral Stricture ◽

Boari Flap ◽

Ureteral Reconstruction ◽

Urinary Drainage ◽

Preserve Renal Function ◽

Psoas Hitch ◽

Invasive Management

The goals for management of ureteropelvic junction obstruction (UPJO) and ureteral stricture are to resolve obstruction, restore continuity, and preserve renal function while minimizing morbidity. The management of UPJO can be challenging and represents a spectrum of options that vary in the invasiveness and effective. These options include observation, long-term internal or external urinary drainage, and endoscopic or minimally invasive management. Mismanagement can potentially results in deterioration of loss of kidney function. This chapter discusses the foundations for successful management of UPJO and ureteral strictures. It also highlights the special clinical situations related to this disease entity and discusses the key advances in the field. This review contains 8 figures, 4 tables, and 73 references. Key Words: Boari flap, dismembered pyeloplasty, endopyelotomy, psoas hitch, pyeloplasty, ureteropelvic junction obstruction, ureteral obstruction, ureteral reconstruction, ureteral stricture, uretero-ureterostomy

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Magnetic Seed (Magseed) Localisation in Breast Cancer Surgery: A Multicentre Clinical Trial

Breast Care ◽

10.1159/000510380 ◽

2020 ◽

pp. 1-6

Author(s):

Jan Žatecký ◽

Otakar Kubala ◽

Oldřich Coufal ◽

Markéta Kepičová ◽

Adéla Faridová ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Surgical Oncology ◽

Breast Tumour ◽

Axillary Node ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Breast Cancer Patients ◽

Magnetic Marker ◽

Magnetic Seeds

Introduction: The aim of this study was to evaluate the accuracy and reliability of the Magseed magnetic marker in breast cancer surgery. Methods: Thirty-nine patients with 41 implanted Magseeds undergoing surgical treatment in 3 surgical oncology departments were included in the retrospective trial to study pilot use of the Magseed magnetic marker in the Czech Republic for localisation of breast tumours or pathological axillary nodes in breast cancer patients. Results: Thirty-four breast cancer and 7 pathological lymph node localisations were performed by Magseed implantation. No placement failures, or perioperative detection failures of Magseeds were observed (0/41, 0.0%), but one case of Magseed migration was present (1/41, 2.4%). All magnetic seeds were successfully retrieved (41/41, 100.0%). Negative margins were achieved in 29 of 34 (85.3%) breast tumour localisations by Magseed. Conclusion: Magseed is a reliable marker for breast tumour and pathological axillary node localisation in breast cancer patients. Magseed is comparable to conventional localisation methods in terms of oncosurgical radicality and safety.

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Permanent Ureteral Occlusion

10.1093/med/9780199986071.003.0090 ◽

2018 ◽

Author(s):

Almamoon I. Justaniah

Keyword(s):

Clinical Presentation ◽

Percutaneous Nephrostomy ◽

Spontaneous Healing ◽

Ureterovaginal Fistula ◽

Cyanoacrylate Glue ◽

Pelvic Malignancy ◽

Urine Diversion ◽

Ureteral Injuries ◽

Prior Surgery ◽

Ureteral Occlusion

Distal ureteral injuries are uncommon. When present, urine leakage may ensue. Common etiologies are gynecologic surgeries (75%), trauma, pelvic malignancy, and radiation therapy. Clinical presentation varies according to the location of leakage or fistula. For example, patients with ureterovaginal fistula may present with vaginal discharge. Patients with intra-abdominal leakage may develop urinoma or abscess. Unfortunately, most of these patients are poor surgical candidates due to prior surgery and/or radiation. Therefore, operative repair can be challenging and at times not a valid option. Transrenal ureteral occlusion may provide the best available option for such patients. A trial of urine diversion via percutaneous nephrostomy tube may allow spontaneous healing. If this fails, ureteral occlusion proximal to the leak/fistula can be attempted with a success rate up to 100%. Occlusion techniques include ureteral clipping, radiofrequency cauterization, embolization coils, Amplatzer vascular plugs, detachable balloons, absolute alcohol, and isobutyl-2-cyanoacrylate (glue).

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Basic Standard Procedure of Abdominal Hysterectomy: Part 1

The Surgery Journal ◽

10.1055/s-0039-1678575 ◽

2019 ◽

Vol 05 (S 01) ◽

pp. S2-S10

Author(s):

Yuji Hiramatsu

Keyword(s):

Standard Procedure ◽

Outer Wall ◽

Total Abdominal Hysterectomy ◽

Ureteral Injury ◽

Abdominal Hysterectomy ◽

Second Step ◽

Bladder Injury ◽

Intestinal Damage ◽

Cardinal Ligament ◽

Basic Standard

Total abdominal hysterectomy (TAH) is commonly referred to as extrafascial hysterectomy. This article explains the basic surgical procedure of TAH as taught to residents. TAH is an operation to remove the uterus with the outer wall of the uterus, and is a fundamental operation that gynecologists must master. Possible complications during TAH include ureteral injury, intestinal damage, and bladder injury. To avoid operative complications, it is important to follow the correct release layer procedure and ensure that “the uterus has been naturally removed.”The two most important points of the authors' method to avoid complications are as follows: (1) cut sequentially from the ligament away from the ureter which moves the ureter further away from the cervix with each transection stage; (2) cut the parametrial tissue along the circumference of the cervix in the next three steps:First step: clamping and cutting the uterine artery and upper part of the cardinal ligament; second step: clamping and cutting the sacrouterine ligament and the posterior half of the cardinal ligament; third step: clamping and cutting the vesicouterine ligament and anterior half of the cardinal ligament.

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