scholarly journals Urological complications after radical hysterectomy: Incidence rates and predisposing factors

2007 ◽  
Vol 64 (6) ◽  
pp. 381-384 ◽  
Author(s):  
Ivana Likic-Ladjevic ◽  
Sasa Kadija ◽  
Nebojsa Ladjevic ◽  
Aleksandar Stefanovic ◽  
Rajka Argirovic ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Radical Hysterectomy ◽  
Postoperative Infection ◽  
Cervix Uteri ◽  
Bladder Injury ◽  
Predisposing Factor ◽  
Stage Ib ◽  
Ureteral Injuries ◽  
Urological Complications ◽  
Bladder Injuries

Bacground/Aim. Radical hysterectomy is a surgical approach for stage Ib and IIa of cervical cancer. The incidence of intraoperative injuries of the bladder during radical hysterectomy ranges from 0.4-3.7%. The ureter can be crushed, caught in sutures, transsected, obstructed by angulation, or ischemic by the stippling or periureteric fascia. Vesicovaginal and ureterovaginal fistuls are reported to develop in 0.9-2% of patients after radical abdominal hysterectomy. Fistulas usually become manifested or visible at speculum examination within 14 days following the surgery. The aim of this study was to establish the incidence and predisposing factor of urological complications after radical hysterectomy. Methods. The study included a total of 536 patients with invasive stage Ib to IIb cancer of the cervix uteri who had underwent radical hysterectomy. The special elements considered were: the patient?s age; the International Federation of Ginecology and Obstetrics (FIGO) stage after pathohistology; duration of operation; the result of preoperative laboratory tests for diabetes, anemia, hypoproteinemia, or disorders of liver or kidney function; ASA status; postoperative surgical infection. Results. The average age of the patients with complications was 48.68 years. All patients with intraoperative ureteric and bladder injuries had statisticaly significant higher stage of disease and operation lasted more than in others without injury. We noticed 1.3% ureteral injuries and 1.49% bladder injuries, more than 50% of the patients with a previously mentioned injuries were operated on more than 3 hours. We found 2.61% vesicovaginal and 2.43% ureterovaginal fistuls. A total of 50% of the patients with bladder injury and vesicovaginal fistuls and 70% of the patients with ureterovaginal fistuls had diabetes mellitus. Postoperative infection of surgical site is a very important factor for the development of fistule. Half of the patients with vesicovaginal fistuls had abscess of vaginal cuff. Conclusion. The stage of the disease seem to be the most significant factor in the development of intraoperative ureter and bladder injuries. The stage of the disease, intraoperative bladder injury, diabetes mellitus and postoperative infection of surgical site are the most significant factors in the development of postoperative fistuls. .

scholarly journals URINARY TRACT INJURIES FOLLOWING OBSTETRIC AND GYNECOLOGIC SURGERIES -A PROSPECTIVE STUDY IN A TERTIARY CARE HOSPITAL.

2020 ◽  
pp. 67-68
Author(s):  
Khumallambam Ibomcha Singh ◽  
Konsam Jina Devi ◽  
Kangjam Sholay Meitei
Keyword(s):  
Urinary Tract ◽  
Vesicovaginal Fistula ◽  
Tertiary Care ◽  
Ureteral Injury ◽  
Gynecologic Surgery ◽  
Bladder Injury ◽  
Care Hospital ◽  
Ureterovaginal Fistula ◽  
Ureteral Injuries ◽  
Urological Complications

Purpose: Urinary tract injuries occur frequently during surgery in the pelvic cavity. Inadequate diagnosis and treatment may lead to severe complications and morbidities. This study examined the clinical features of urologic complications following obstetric and gynecologic surgery and their management. Materials and Methods: We prospectively analysed 14,678 obstetric and gynecologic surgery cases from May 2015 to May 2019. Twenty-one patients with urological complications were enrolled. This study assessed the etiology and surgical approach, type, and treatment method of the urologic injury. Results: Of these 21 patients, 11 had bladder injury, 1 had ureteral injury, 1 had combined bladder and ureteral injury, 8 had vesicovaginal fistula and 5 had ureterovaginal fistula. With respect to injury rate by specific surgery, radical hysterectomy was the highest with 5 of 21 cases. Out of 11 cases of bladder injury, only one underwent laparoscopic bladder repair and the rest had transabdominal primary repair during surgery with a 100% success rate. Two of 7 ureteral injuries were identified intraoperatively. One underwent ureteroureterostomy and another had ureteroneocystostomy with no major complications. All 8 cases of vesicovaginal fistula had open transabdominal O’ connor repair and all 5 cases of ureterovaginal fistula were cured after ureteroneocystostomy following percutaneous nephrostomy. Conclusions: Urinary bladder injury was the most common urological injury during obstetric and gynecologic surgery, followed by ureteral injury. The types of injured states, diagnostic difficulty, and time to complete cure were much greater among patients with ureteral injuries. Early diagnosis and necessary urologic intervention are important for better outcome.

scholarly journals Causes and prevention of Iatrogenic fistula during Gynaecologic Surgery

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Ashudeep Sharma
Keyword(s):  
Ureteral Injury ◽  
Pelvic Surgery ◽  
Minimal Risk ◽  
Predisposing Factor ◽  
Advanced Malignancy ◽  
Ureteral Injuries ◽  
Severity Of Injury ◽  
Bladder Injuries ◽  
Urologic Injury

Pelvic surgery is most common cause of iatrogenic ureteral injury. The incidence of ureteric range from 0.2 to 1% during various gynaecological procedure including laparoscopic surgery. The majority of ureteral injury has no identifiable predisposing factor and occurs more frequently for procedure forbenign lesion. Two third of injury are diagnosed postoperative period. When the injury is recognized intra-operatively, the lesion can be repaired immediately with minimal risk of long term sequelae.  Urological injuries to urinary bladder & ureter- uncommon but important. Surgical complications during various obstetric & gynecological open and laparoscopic procedures. One of the important factors is anatomic proximity of ureters & bladder to genital tract. Bladder injuries- most frequent urologic injury. Bladder injuries usually recognized and repaired immediately, and potential complications are typically minor. But ureteral injuries(70%) typically are not recognized immediately & can lead to long term complications. Risk factors are Enlarged uterus, Previous pelvic surgery or radiation, Advanced malignancy Endometriosis, PID ,Pelvic adhesions, distorted pelvic anatomy. Iatrogenic urologic injuries can be prevented by adequate pre-operative assessment, good surgical technique, and visualization of the bladder & ureters. Anticipation and high index of suspicion, early urological referral, and appropriate investigation of suspected urologic injury is of paramount importance. Post-operatively they may present with fever, flank pain and tenderness, oligouria, anuria, uremia, ileus, peritonitis, urinary leakage and hematuria depending upon severity of injury. To prevent ureteral injury surgeon must have thorough knowledge of anatomy and location of ureter during various gynaecological procedure and the specific sites where it is most susceptible to injury.

Oncologic Results and Surgical Morbidity of Laparoscopic Nerve-Sparing Radical Hysterectomy in the Treatment of FIGO Stage IB Cervical Cancer: Long-Term Follow-Up

2011 ◽  
Vol 21 (2) ◽  
pp. 355-362 ◽  
Author(s):  
Nae Yoon Park ◽  
Gun Oh Chong ◽  
Dae Gy Hong ◽  
Young Lae Cho ◽  
Il Soo Park ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Survival Rates ◽  
Operating Time ◽  
Figo Stage ◽  
Nerve Sparing ◽  
Surgical Morbidity ◽  
Stage Ib ◽  
Urological Complications ◽  
Long Term Follow Up

Objectives:The aim of this study was to evaluate a long-term follow-up data for oncologic results and surgical morbidity of a laparoscopic nerve-sparing radical hysterectomy (NSRH) in the treatment of FIGO stage IB cervical cancer.Methods:This was a retrospective study that comprised consecutive 125 patients with cervical cancer stage IB1 (n = 105) and IB2 (n = 20) who underwent a laparoscopic NSRH (Piver type III) by a gynecologic oncologist without selecting patients from January 1999 to December 2007.Results:In regression analysis, the operating time (R2linear = 0.311,P< 0.001) and estimated blood loss (R2linear = 0.261,P< 0.001) were decreased, whereas the number of harvested pelvic lymph nodes (R2linear = 0.250,P< 0.001) was increased. Seventeen patients (13.6%, 17/125) were found to have pelvic node metastasis. Para-aortic node metastasis had occurred in 2 patients (5.1%, 2/39). There were high urological complications (13/125, 10.4%) related to radical surgery. Forty-one patients (33%) needed transfusions. Positive surgical margins did not exist. Patients were able to self-void at a mean of 10.3 days postoperatively. The return rates to normal voiding function at postoperative 14 and 21 days were 92.0% and 95.2%, respectively. Thirteen patients (IB1 n = 9, IB2 n = 4) experienced a recurrence postoperatively. Six patients (IB1 n = 3, IB2 n = 3) died of recurrent disease. Five-year disease-free survival rates of cervical cancer IB1 and IB2 were 92% and 78%, respectively (P= 0.1772). Five-year overall survival rates of cervical cancer IB1 and IB2 were 96% and 83%, respectively (P= 0.0437).Conclusions:A laparoscopic NSRH for FIGO stage IB cervical cancer was comparable to open NSRH in terms of early recovery of bladder function. It did not compromise surgical radicality, but revealed high urological complications, long operating time, and much blood loss, compared with conventional radical hysterectomy. However, these surgical morbidities were corrected with increase in experiences.

Bulky Stage IB Cervical Carcinoma Managed by Primary Radical Hysterectomy Followed by Tailored Radiotherapy

1993 ◽  
Vol 48 (4) ◽  
pp. 266-268
Author(s):  
JEFFREY D. SLOSS ◽  
MICHAEL L. BERMAN ◽  
J. MUKHERERJEE ◽  
ALBERTO MANETTA ◽  
DENNIS EMMA ◽  
...  
Keyword(s):  
Cervical Carcinoma ◽  
Radical Hysterectomy ◽  
Primary Radical ◽  
Stage Ib

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.

scholarly journals Fournier's Gangrene: Non-Clostridial Gas Gangrene of the Perineum and Diabetes Mellitus

1986 ◽  
Vol 79 (4) ◽  
pp. 212-215 ◽  
Author(s):  
A J Lamerton
Keyword(s):  
Diabetes Mellitus ◽  
Fournier’S Gangrene ◽  
Gas Gangrene ◽  
Fournier's Gangrene ◽  
Predisposing Factor

Three successfully managed cases of Fournier's gangrene, all with diabetes, are reported. A simple bacteriological classification is offered and the importance of diabetes mellitus as a predisposing factor is stressed.

scholarly journals Bladder injuries in emergency/expedited laparoscopic surgery in the absence of previous surgery: a case series

2012 ◽  
Vol 94 (3) ◽  
pp. e118-e120 ◽  
Author(s):  
BF Levy ◽  
J De Guara ◽  
PD Willson ◽  
Y Soon ◽  
A Kent ◽  
...  
Keyword(s):  
Case Series ◽  
Lower Abdominal Pain ◽  
Bladder Injury ◽  
Emergency Setting ◽  
Surgical Trainees ◽  
Bladder Injuries ◽  
Site Planning ◽  
Supervision And Training ◽  
Alternative Sites ◽  
And Training

INTRODUCTION The use of laparoscopy as a diagnostic and therapeutic tool is being used increasingly in the emergency setting with many of these procedures being performed by trainees. While the incidence of iatrogenic injuries is reported to be low, we present six emergency or expedited cases in which the bladder was perforated by the suprapubic trocar. CASES Three cases were related to the management of appendicitis, two to negative diagnostic laparoscopies for lower abdominal pain and one to an ectopic pregnancy. Management of the bladder injuries varied from a urinary catheter alone to laparotomy with debridement of the abdominal wall due to sepsis and later reconstruction. Four of the six cases were performed by registrars. CONCLUSIONS Although the incidence of bladder injury is low, its importance is highlighted by the large number of laparoscopies being performed. In addition to catheterisation of the patient, care must be taken with the insertion of low suprapubic ports and consideration should be made regarding alternative sites. Adequate laparoscopic supervision and training in port site planning is required for surgical trainees.

scholarly journals Machine Learning and In Vitro Chemical Screening of Potential α-Amylase and α-Glucosidase Inhibitors from Thai Indigenous Plants

Nutrients ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 267
Author(s):  
Tarapong Srisongkram ◽  
Sasisom Waithong ◽  
Thaweesak Thitimetharoch ◽  
Natthida Weerapreeyakul
Keyword(s):  
Diabetes Mellitus ◽  
Machine Learning ◽  
Inhibitory Activity ◽  
In Vitro Study ◽  
Ethanolic Extract ◽  
Accuracy Score ◽  
Indigenous Plants ◽  
Predisposing Factor ◽  
Chemical Screening

Diabetes mellitus is a major predisposing factor for cardiovascular disease and mortality. α-Amylase and α-glucosidase enzymes are the rate-limiting steps for carbohydrate digestion. The inhibition of these two enzymes is clinically used for the treatment of diabetes mellitus. Here, in vitro study and machine learning models were employed for the chemical screening of inhibiting the activity of 31 plant samples on α-amylase and α-glucosidase enzymes. The results showed that the ethanolic twig extract of Pinus kesiya had the highest inhibitory activity against the α-amylase enzyme. The respective ethanolic extract of Croton oblongifolius stem, Parinari anamense twig, and Polyalthia evecta leaf showed high inhibitory activity against the α-glucosidase enzyme. The classification analysis revealed that the α-glucosidase inhibitory activity of Thai indigenous plants was more predictive based on phytochemical constituents, compared with the α-amylase inhibitory activity (1.00 versus 0.97 accuracy score). The correlation loading plot revealed that flavonoids and alkaloids contributed to the α-amylase inhibitory activity, while flavonoids, tannins, and reducing sugars contributed to the α-glucosidase inhibitory activity. In conclusion, the ethanolic extracts of P. kesiya, C. oblongifolius, P. anamense, and P. evecta have the potential for further chemical characterization and the development of anti-diabetic recipes.

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