Iatrogenic ureteral trauma: A 16-year single tertiary centre experience

Introduction. Iatrogenic ureteral injuries can occur during various abdominopelvic and retroperitoneal surgical procedures including gynecological, urological, colorectal and vascular. Objective. The aim of our study was to examine the incidence and types of iatrogenic ureteral injuries occurred over the period of 16 years, as well as to evaluate the values of applied diagnostic and therapeutic procedures. Methods. A retrospective analysis of clinical data (medical records and operative reports) of 55 patients (11 male and 44 female; mean age 54.5 years) with verified iatrogenic ureteral injury from 1998 to 2014, was performed. Results. Iatrogenic ureteral injuries occurred during gynecological procedures in 55%, urological in 25%, colorectal in 15% and vascular in 5% of cases. Mechanisms of injury were incomplete transection (n=23), complete transection (n=1), ligation (n=7), partial perforation (mucosal abrasion) (n=13) and total perforation (n=1). The most frequent diagnostic procedures for postoperative identification of ureteral injuries were abdominal ultrasonography, excretory urography, antegrade pyeloureterography and retrograde ureteropyelography. Early therapeutic procedures were applied in 35 (64%), while delayed in 20 cases (36%). Early (<30 days) or late (>30 days) postoperative complications were verified in 14 cases (25%). Conclusion. Among different surgeries that may lead to the development of iatrogenic ureteral injury, gynecological procedures represent the most common cause. Rapid diagnosis enables immediate ureteral repair and is associated with low morbidity rates, representing a major factor contributing to the treatment success and ultimately preserving the renal function.

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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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Does Endourological Intervention a Suitable Treatment Options in Management of Iatrogenic Thermal Ureteral Injury?

10.22541/au.161556042.26398547/v1 ◽

2021 ◽

Author(s):

Oguz Ozden Cebeci ◽

Tayyar Alp Özkan

Keyword(s):

Thermal Injury ◽

Treatment Options ◽

Treatment Success ◽

Surgical Techniques ◽

Ureteral Injury ◽

Gynecologic Surgery ◽

Success Rates ◽

Key Words Ureter ◽

Urological Intervention ◽

Iatrogenic Ureteral Injury

Introduction This study aimed to evaluate the etiological factors and their effects on long-term clinical outcomes in patients with iatrogenic ureteral injury (IUI). Material and Method Twenty-seven patients who underwent surgery because of IUI were evaluated between January 2011 and April 2018. Patients were classified according to the time of diagnosis and the need for reoperation after the urologic intervention. The IUI cases detected during gynecological surgery were called ‘perioperative’ IUI, and those diagnosed late as ‘postoperative’ (delayed) IUI. The IUI type was categorized as ‘cold transection’ due to surgical dissection or ligation and ‘thermal injury’ if it depended on any energy-based surgical device. Results Postoperative diagnosed cases consisted of exclusively after laparoscopic surgery (p=.025). Patients with thermal injury to the ureter were mostly diagnosed postoperatively (p= .021). Patients who underwent endourological intervention, 31.25% (N = 5/16) were diagnosed during gynecologic surgery, and 68.75% (n = 11/16) were diagnosed postoperatively. For open reconstructive surgery, these rates were observed to be 72.72% (n = 8/11) and 27.28% (n = 3/11), respectively (p=.034). IUI was due to thermal injury in all patients who developed complications after the urological intervention (p = .046), and the first urological intervention was endoscopic double loop stenting (p = .005). One of these patients was diagnosed in the perioperative period and seven in the postoperatively (p = .016). Conclusion Treatment success rates are low in patients who underwent endourological intervention after thermal IUI. Therefore, surgical techniques in which the traumatic ureter segment is excised should be preferred to avoid complications. Key Words Ureter, Iatrogenic, Thermal Injury, Iatrogenic Ureteral Injury, Endourological Intervention.

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Renal autotransplantation: A final option to preserve the kidney after an iatrogenic ureteral injury

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2019.4.263 ◽

2020 ◽

Vol 91 (4) ◽

pp. 263-264 ◽

Cited By ~ 1

Author(s):

Napoleon Moulavasilis ◽

Ioannis Katafigiotis ◽

Dimitris Staios ◽

Christos Nikolaidis ◽

Spyridon Vernadakis ◽

...

Keyword(s):

Renal Function ◽

Surgical Procedures ◽

Ureteral Injury ◽

Nephrostomy Tube ◽

Safety And Efficacy ◽

Totally Extraperitoneal ◽

Ureteral Injuries ◽

Renal Autotransplantation ◽

Ureteral Avulsion ◽

Iatrogenic Ureteral Injury

Background: Ureteral injuries are not very common and can occur after many surgical procedures. Kidney salvage is desirable. Renal autotransplantation is a final option for some cases. In this case, we report an autotransplantation of the kidney after an iatrogenic injury of the ureter with totally extraperitoneal approach.Case report: A 41 years old female underwent left endoscopic ureterolithotomy with holmium laser for ureteral calculi. An iatrogenic ureteral injury, probably ureteral avulsion, occurred. After multiple interventions, she referred to us with a nephrostomy tube. Imaging was performed and left renal autotransplantation was chosen as surgical management. The approach was totally extraperitoneal. No alteration of renal function or of urine outflow was observed during the follow up.Conclusions: The report supports the safety and efficacy of renal autotransplantation.

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Interventional radiology in the palliation of cancer

10.1093/med/9780198821328.003.0082 ◽

2021 ◽

pp. 861-871

Author(s):

Tarun Sabharwal ◽

Nicos I. Fotiadis ◽

Andy Adam

Keyword(s):

Palliative Care ◽

Interventional Radiology ◽

Diagnostic Procedures ◽

Venous Access ◽

Patients With Cancer ◽

Therapeutic Procedures ◽

Potential Benefits ◽

Diagnosis Of Cancer ◽

Interventional Radiology Procedures

Interventional radiology uses image guidance to perform minimally invasive therapeutic and diagnostic procedures. It is an integral part of the multidisciplinary team managing patients with cancer. Interventional radiology is involved in all stages of the cancer patient’s journey starting from performing image-guided biopsies for the diagnosis of cancer, venous access procedures, and therapeutic procedures, and focuses on the palliation of symptoms and improvement in the quality of life. All interventional procedures carry some risk, which is related to the underlying condition, the nature of the procedure, and the experience of the radiologist. Therefore, it is important in patients with advanced malignant disease receiving palliative care to contemplate only those procedures that will alleviate symptoms, and in which the potential benefits outweigh the risks. This chapter presents the drainage, stenting, feeding, embolization, ablation, and supportive interventional radiology procedures which could potentially benefit patients undergoing palliative care. The focus will be on the indications, contraindications, and likely outcomes, rather than on detailed technical descriptions.

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Malpractice Litigation in Iatrogenic Ureteral Injury: a Legal Database Review

Urology ◽

10.1016/j.urology.2020.08.049 ◽

2020 ◽

Vol 146 ◽

pp. 19-24

Author(s):

Raevti Bole ◽

Brian J. Linder ◽

Ajay Gopalakrishna ◽

Ruby Kuang ◽

Ashton L. Boon ◽

...

Keyword(s):

Ureteral Injury ◽

Malpractice Litigation ◽

Iatrogenic Ureteral Injury

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Isolated Jejunal Perforation and Mesentery Injury following a Kick on the Abdomen of a College Student: A Case Report from a District Hospital in Northern Ghana

Case Reports in Critical Care ◽

10.1155/2020/3063472 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Engelbert A. Nonterah ◽

Solomon Atindama ◽

Emmanuel Achumbowina ◽

Michael B. Kaburise ◽

Edwin Saanwie ◽

...

Keyword(s):

College Student ◽

Bowel Perforation ◽

Diagnostic Procedures ◽

Adverse Outcomes ◽

Northern Ghana ◽

Diagnostic Challenge ◽

Abdominal Ultrasonography ◽

Delay In Diagnosis ◽

High Index Of Suspicion ◽

Physical Findings

Introduction. Isolated jejunal perforation from blunt abdominal trauma is an extremely rare intra-abdominal injury that poses a huge diagnostic challenge. Delay in diagnosis and initiation of treatment often leads to significant morbidity and mortality. Diagnosis particularly in resource-poor settings may be extremely challenging and often relies on a high index of suspicion. This is due to lack of adequate diagnostic facilities and human resource to deal with the condition with resulting high occurrence of adverse outcomes. Case Presentation. We report a case of isolated jejunal perforation with associated mesentery injury in a young college student who sustained a kick to his abdomen while playing soccer. This is an unusual presentation since most reported cases often resulted from motor vehicular accidents, bicycle handlebar, and fall from a height. We emphasized the role of critical level of suspicion with a good history and physical examination as the major source of diagnosis since diagnostic procedures, such as abdominal ultrasonography and computed tomography, are largely unavailable in most resource-constraint settings. Early surgical intervention following diagnosis leads to good recovery and reduced mortality. Conclusion. Sufficient vigilance and suspicions of small bowel perforation should always be considered after blunt trauma even when symptoms and physical findings are minimal and when diagnostic capacity is limited.

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Recognition and Management of Colonic Perforation following Endoscopy

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0038-1677024 ◽

2019 ◽

Vol 32 (03) ◽

pp. 183-189

Author(s):

Earl Thompson ◽

Jonathan Snyder

Keyword(s):

Early Diagnosis ◽

Diagnostic Imaging ◽

Primary Repair ◽

Clinical Status ◽

Surgical Techniques ◽

Mechanical Bowel Preparation ◽

Diagnostic Procedures ◽

Colonic Perforation ◽

Therapeutic Procedures ◽

High Degree

AbstractAlthough rare, perforation can be a devastating complication of colonoscopy. Incidence ranges from 0.012 to 0.65% during diagnostic procedures and is higher in therapeutic procedures. Early diagnosis and management are of paramount importance to decrease morbidity. Diagnostic imaging after colonoscopy can reveal extraintestinal air, but overall clinical status including leukocytosis, fever, pain, and peritonitis is equally important to determine management. With the expanding availability of complex endoscopic interventions, an increasing number of perforations are recognized during colonoscopy or immediately afterward based on high degree of suspicion. Colonoscopic management of these early perforations may be feasible and avoid the morbidity of surgery. Patients who require surgery may be managed with laparoscopic or open surgical techniques. Surgical management may consist of primary repair of the injury, resection with anastomosis, or resection with ostomy. Mechanical bowel preparation before endoscopy decreases fecal contamination after perforation, often obviating the need for ostomy creation.

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Crossed renal ectopia with fusion in a female feline: case report

Arquivo Brasileiro de Medicina Veterinária e Zootecnia ◽

10.1590/1678-4162-10533 ◽

2019 ◽

Vol 71 (3) ◽

pp. 833-836 ◽

Cited By ~ 1

Author(s):

J.Q. Fulgêncio ◽

F.G. Miranda ◽

C.J. Santos ◽

G.D. Moreira ◽

R.C.S. Tôrres ◽

...

Keyword(s):

Renal Function ◽

Case Report ◽

Diagnostic Imaging ◽

Final Diagnosis ◽

Excretory Urography ◽

Abdominal Ultrasonography ◽

Renal Ectopia ◽

Mixed Breed ◽

Crossed Renal Ectopia ◽

The Right

ABSTRACT A 3 year old female feline of mixed breed was sent to the diagnostic imaging sector under suspicion of bleeding due to ovariohysterectomy. An abdominal ultrasonography was performed to confirm the initial suspicion. However, no signs of bleeding were found, instead it was observed that the left renal silhouette had two pelvises and was elongated and larger than normal. The right kidney was not found. Excretory urography was requested to evaluate the condition of the ureters. The final diagnosis was crossed renal ectopia with fusion in an asymptomatic cat with no changes in renal function.

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