scholarly journals Managing Ureterovaginal Fistulas following Obstetric and Gynecological Surgeries

2018 ◽  
Vol 16 (2) ◽  
pp. 233-238 ◽  
Author(s):  
Amit Mani Upadhyay ◽  
Ashok Kunwar ◽  
Sanjesh Shrestha ◽  
Hema Kumari Pradhan ◽  
Aruna Karki ◽  
...  
Keyword(s):  
Surgical Outcome ◽  
Guide Wire ◽  
Endoscopic Management ◽  
Ureterovaginal Fistula ◽  
Ureteric Injury ◽  
Distal Ureter ◽  
Primary Surgery ◽  
Ureteric Injuries ◽  
Vesicoureteric Junction ◽  
Fistula Site

Background: Iatrogenic ureteric injuries leading to fistula are rare but devastating complications of obstetric and gynecological surgeries. The aim of the study was to review the demography of ureterovaginal fistula (UVF) and its surgical outcome in Kathmandu Model Hospital.Methods: This is a review of 15 patients of ureterovaginal fistula who were referred to department of Obstetrics and Gynaecology of Kathmandu Model Hospital from Feb 2014 to Sept 2017. We reviewed the demography, causesand surgical outcome of ureterovaginal fistula (UVF). Ten patients who had complete blind end at the distal ureter, underwent Lich-Gregoir extravesical ureteroneocystostomy. In other five patients, guide wire was successfully negotiated beyond the fistula site, however retrograde double J stenting could be done in only four patients.Results: All the patients had distal ureteric injury close to vesicoureteric junction leading to ureterovaginal fistula. Among them, majority were due to post-hysterectomy in 60% (n=9) followed by obstetrical procedures in 40% (n=6). Fourteen patients (93%) had successful closure of the fistula with complete preservation of renal function. Retrograde double J stenting was possible in patients who were referred earlier within two weeks of the onset of injury.Conclusions: Iatrogenic injury to the distal ureter during surgery was the leading cause for the ureterovaginal fistula. Endoscopic management with ureteric stents was still possible if the patients were referred earlier following primary surgery.

Managing Ureterovaginal Fistulas following Obstetric and Gynecological Surgeries

2018 ◽  
Vol 16 (2) ◽  
pp. 233-238
Author(s):  
Amit Mani Upadhyay ◽  
Ashok Kunwar ◽  
Sanjesh Shrestha ◽  
Hema Kumari Pradhan ◽  
Aruna Karki ◽  
...  
Keyword(s):  
Surgical Outcome ◽  
Guide Wire ◽  
Endoscopic Management ◽  
Ureterovaginal Fistula ◽  
Ureteric Injury ◽  
Distal Ureter ◽  
Primary Surgery ◽  
Double J Stent ◽  
Ureteric Injuries ◽  
Vesicoureteric Junction

Background: Iatrogenic ureteric injuries leading to fistula are rare but devastating complications of obstetric and gynecological surgeries. The aim of the study was to review the demography of ureterovaginal fistula (UVF) and its surgical outcome in Kathmandu Model Hospital.Methods: This is a review of 15 patients of ureterovaginal fistula who were referred to department of Obstetrics and Gynaecology of Kathmandu Model Hospital from Feb 2014 to Sept 2017. We reviewed the demography, causes and surgical outcome of ureterovaginal fistula (UVF). Ten patients who had complete blind end at the distal ureter, underwent Lich-Gregoir extravesical ureteroneocystostomy. In other five patients, guide wire was successfully negotiated beyond the fistula site, however retrograde double J stenting could be done in only four patients.Results: All the patients had distal ureteric injury close to vesicoureteric junction leading to ureterovaginal fistula. Among them, majority were due to post-hysterectomy in 60% (n=9) followed by obstetrical procedures in 40% (n=6). Fourteen patients (93%) had successful closure of the fistula with complete preservation of renal function. Retrograde double J stenting was possible in patients who were referred earlier within two weeks of the onset of injury. Conclusions: Iatrogenic injury to the distal ureter during surgery was the leading cause for the ureterovaginal fistula. Endoscopic management with ureteric stents was still possible if the patients were referred earlier following primary surgery. Keywords: Double J stent; iatrogenic ureteric injury; ureterovaginal fistula; ureteroneocystostomy.

scholarly journals Experience of Managing Ureterovaginal Fistulas following Obstetric and Gynecological Surgeries

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Amit Mani Upadhyay ◽  
Ashok Kunwar ◽  
Sanjesh Shrestha ◽  
Hema Kumari Pradhan ◽  
Aruna Karki ◽  
...  
Keyword(s):  
Surgical Outcome ◽  
Guide Wire ◽  
Short Review ◽  
Endoscopic Management ◽  
Ureterovaginal Fistula ◽  
Ureteric Injury ◽  
Distal Ureter ◽  
Primary Surgery ◽  
Ureteric Injuries ◽  
Vesicoureteric Junction

Aims: Iatrogenic ureteric injuries leading to fistula are rare but devastating complications of obstetric and gynecological surgeries.The aim of the study is to review the demography of ureterovaginal fistula (UVF) and its surgical outcome in the starting phase of fistula surgery. Methods: This is a retrospective review of 15 patients of ureterovaginal fistula who were referred to department of Obstetrics and Gynaecology of Kathmandu Model Hospital from Feb 2014 to Sept 2017. The study reviewed the demography, causes and surgical outcome of ureterovaginal fistula (UVF). Ten patients who had complete blind end at the distal ureter undergone Lich-Gregoir extravesicalur enteroneocystostomy.  In other 5 patients, guide wire was successfully negotiated beyond the fistula site, however retrograde double J stenting  could be done in only 4 patients. Results: All the patients had distal ureteric injury close to vesicoureteric junction leading to ureterovaginal fistula. Among them, majority were due to post hysterectomy 60% (n=9) followed by obstetrics procedures (caesarean section) 40% (n=6). Fourteen patients (93%) had successful closure of the fistula with complete preservation of renal function till date. Retrograde double J stenting was possible in patients who were referred earlier within two weeks of the onset of injury. Conclusions: In our short review, iatrogenic injury to the distal ureter during Obstetrics/Gynaecologic surgery was found to be the leading cause for the formation of ureterovaginal fistula. Endoscopic management with ureteric stents is still possible if the patients are referred earlier following primary surgery.

scholarly journals Our Experience with Iatrogenic Ureteric Injuries among Women Presenting to University College Hospital, Ibadan: A Call to Action on Trigger Factors

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Olatunji Lawal ◽  
Oluwasomidoyin Bello ◽  
Imran Morhason-Bello ◽  
Rukiyat Abdus-salam ◽  
Oladosu Ojengbede
Keyword(s):  
Postoperative Complications ◽  
Caesarean Section ◽  
Caesarean Delivery ◽  
Abdominal Hysterectomy ◽  
Ureterovaginal Fistula ◽  
Ureteric Injury ◽  
College Hospital ◽  
University College ◽  
Retrospective Data Collection ◽  
Ureteric Injuries

Background. Ureteric injuries leading to ureterovaginal fistula (UVF) is less common than vesicovaginal fistula, as a cause of urinary incontinence. Recently, there is a surge in the number of UVF cases presenting to University College Hospital (UCH) following a caesarean delivery. The urogynaecology unit at UCH is at the forefront of providing surgical repair for women with all forms of genitourinary fistulas. We describe our experience with managing UVF arising from ureteric injury. Methods. A retrospective data collection of UVF cases managed from January 2012–December 2017 at UCH is presented. Information on sociodemographic and obstetric characteristics, presenting complaints, antecedent surgery, treatment received, findings at surgery, and postoperative complications were obtained with a structured proforma. Results. Eighteen cases of UVFs due to iatrogenic ureteric injury were managed. Majority (N=11; 61.1%) of the women suffered the injury following the emergency caesarean section (EMCS). Abdominal hysterectomy operation accounted for four (22.2%) cases, and one case each (5.6%) was due to vaginal hysterectomy and destructive operations. Prolonged obstructed labour (POL) (81.8%) was the most common indication for the EMCS, while 18.2% had surgery on account of lower uterine segment fibroid. Most of the ureteric injuries were on the left side. Postoperative complications documented were haemorrhage, urinary tract infection, wound infection, and injury to the neighbouring structure. Conclusion. Caesarean section being one of the most performed surgical operations in Nigeria was surprisingly found to be the most common cause of ureteric injury ahead of hysterectomy. It is a pointer that the surgeons might not have properly learnt the art of the caesarean delivery well. We recommend adequate surgical training of medical officers/surgeons that are involved.

scholarly journals The Management of Bilateral Ureteric Injury following Radical Hysterectomy

2008 ◽  
Vol 2008 ◽  
pp. 1-4 ◽  
Author(s):  
Matthew B. K. Shaw ◽  
Mark Tomes ◽  
David A. Rix ◽  
Trevor J. Dorkin ◽  
Lakkur N. S. Murthy ◽  
...  
Keyword(s):  
Radical Hysterectomy ◽  
Ureterovaginal Fistula ◽  
Ureteric Injury ◽  
Ureteric Reimplantation ◽  
Recurrent Stricture ◽  
Ureteric Stenting ◽  
Ureteric Stents ◽  
Initial Placement ◽  
Primary Management ◽  
Ureteric Injuries

Iatrogenic ureteric injury is a well-recognised complication of radical hysterectomy. Bilateral ureteric injuries are rare, but do pose a considerable reconstructive challenge. We searched a prospectively acquired departmental database of ureteric injuries to identify patients with bilateral ureteric injury following radical hysterectomy. Five patients suffered bilateral ureteric injury over a 6-year period. Initial placement of ureteric stents was attempted in all patients. Stents were placed retrogradely into 6 ureters and antegradely into 2 ureters. In 1 patient ureteric stents could not be placed and they underwent primary ureteric reimplantation. In the 4 patients in which stents were placed, 2 were managed with stents alone, 1 required ureteric reimplantation for a persistent ureterovaginal fistula, and 1 developed a recurrent stricture. No patient managed by ureteric stenting suffered deterioration in serum creatinine. We feel that ureteric stenting, when possible, offers a safe primary management of bilateral ureteric injury at radical hysterectomy.

scholarly journals Endourological Management of Iatrogenic Ureterovaginal Fistula following Obstetric and Gynecological Surgeries at Tertiary Referral Center

2020 ◽  
Vol 15 (1) ◽  
pp. 62-67
Author(s):  
Amit Mani Upadhyay ◽  
Bigyan Acharya ◽  
Ashok Kumar Kunwar ◽  
Kabir Tiwari ◽  
Sanjesh Bhakta Shrestha ◽  
...  
Keyword(s):  
Guide Wire ◽  
Intravenous Urography ◽  
Successful Outcome ◽  
Ureterovaginal Fistula ◽  
Ureteric Injury ◽  
Tertiary Referral Center ◽  
Double J Stent ◽  
Methylene Blue Test ◽  
Dj Stent ◽  
Ct Urogram

Aims: To evaluate the outcome of endourological management of iatrogenic ureterovaginal fistula caused by gynecological and obstetric surgeries. Methods: This is a retrospective analysis of uretorovaginal fistula (UVF) patients who underwent UVF management with endourology technique from February 2014 to November 2019. All data were taken from fistula database. All non-obstetric/gynaecological cases and open surgical procedures leading to UVF were excluded. Diagnostic evaluation by cystoscopy and ureterorenoscopy; and use of guide wire, C-arm and DJ stent were recorded. Three to six months post-operative follow up status was also recorded. Results: There were 14 cases managed by retrograde DJ stenting. Both hysterectomy (n=10) and Cesarean Sections (n=4) were the past surgeries. Diagnosis was made by history, methylene blue test, cystoscopy, intravenous urography and CT urogram. Treatment was retrograde DJ stenting. All of them had unilateral distal ureteric injury close to vesicoureteric junction leading to ureterovaginal fistula. All were continent at the end. Conclusions: Endourological approach with retrograde DJ stenting had successful outcome in iatrogenic UVF. Keywords: double J stent, endourological technique, iatrogenic ureterovaginal fistula, ureterorenoscope.

Endoscopic Management of Total Ureteral Occlusion and Ureterovaginal Fistula

1995 ◽  
Vol 9 (5) ◽  
pp. 391-396 ◽  
Author(s):  
JAMES E. LINGEMAN ◽  
MICHAEL Y.C. WONG ◽  
JAY R. NEWMARK
Keyword(s):  
Endoscopic Management ◽  
Ureterovaginal Fistula ◽  
Ureteral Occlusion

scholarly journals Iatrogenic ureteric injuries in urological surgeries- a tertiary hospital experience.

2020 ◽  
Vol 27 (12) ◽  
pp. 2558-2563
Author(s):  
Muhammad Mansoor
Keyword(s):  
Case Series ◽  
Tertiary Hospital ◽  
Ureteric Injury ◽  
Common Time ◽  
Satisfactory Outcome ◽  
Late Treatment ◽  
Urological Procedures ◽  
Type Of Injury ◽  
Ureteric Injuries ◽  
Prompt Diagnosis

Objectives: To review our experience in the management of iatrogenic ureter injuries caused by different urological procedures. Study Design: Descriptive Case series. Setting: Department of Urology, Jinnah Postgraduate Medical Centre Karachi. Period: January 2011 to December 2018. Material & Methods: We included all cases of iatrogenic ureteric injuries induced by urology department only. Gynecological and general surgical iatrogenic injuries were excluded in this study. All pertinent details like indication for surgery, type of surgery, location of injury, laterality, type of injury, time of recognition of injury (i-e intra-operative, early and late), treatment modality and their surgical outcomes were recorded. Results: We managed 56 iatrogenic ureteric injuries in 47 patients during study period. Mean age was 43.14+ 8.86 years. There were 31 males (66%) and 16 females (34%). Right sided injury was observed in 29 patients (61.7%), left sided injury in 16 patients (34.0%) while bilateral injuries were seen in 2 patients (4.3%). Regarding site of injury proximal ureteric injuries were the most common accounting for 32 patients (68.1%). Intraoperative diagnosis was the most common time for diagnosis seen in 30 patients (63.8%). The endoscopic urological surgeries were the most common cause of urological iatrogenic ureteric injury accounts for 71.4% of cases. Open upper tract surgeries were responsible for 8 cases (14.2%). One patient sustained proximal ureteric injury during retro-peritoneal lymph node dissection (RPLND). Laparoscopic urological surgeries were responsible for four cases of injury. One patient developed ureteric avulsion. 13 patients presented with late Ureteric stricture. We have five nephrectomies while three patients needed permanent nephrostomies. Our success rate was 83%. Conclusions: Endo-urological   procedures are the commonest causes of ureteric injuries in our study. Prompt diagnosis and early corrective intervention can result in satisfactory outcome in about 83% of cases.

scholarly journals Comprehensive Management of Upper Tract Urothelial Carcinoma

2009 ◽  
Vol 2009 ◽  
pp. 1-14 ◽  
Author(s):  
Georgios Koukourakis ◽  
Georgios Zacharias ◽  
Michael Koukourakis ◽  
Kiriaki Pistevou-Gobaki ◽  
Christos Papaloukas ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
The United States ◽  
Upper Urinary Tract ◽  
Endoscopic Management ◽  
Ureteral Orifice ◽  
Cancer Specific Survival ◽  
Distal Ureter ◽  
Upper Tract

Urothelial carcinoma of the upper urinary tract represents only 5% of all urothelial cancers. The 5-year cancer-specific survival in the United States is roughly 75% with grade and stage being the most powerful predictors of survival. Nephroureterectomy with excision of the ipsilateral ureteral orifice and bladder cuff en bloc remains the gold standard treatment of the upper urinary tract urothelial cancers, while endoscopic and laparoscopic approaches are rapidly evolving as reasonable alternatives of care depending on grade and stage of disease. Several controversies remain in their management, including a selection of endoscopic versus laparoscopic approaches, management strategies on the distal ureter, the role of lymphadenectomy, and the value of chemotherapy in upper tract disease. Aims of this paper are to critically review the management of such tumors, including endoscopic management, laparoscopic nephroureterectomy and management of the distal ureter, the role of lymphadenectomy, and the emerging role of chemotherapy in their treatment.

scholarly journals Results of surgical and somatostatin analog therapies and their combination in acromegaly: a retrospective analysis of the German Acromegaly Register

2008 ◽  
Vol 159 (5) ◽  
pp. 525-532 ◽  
Author(s):  
S Petersenn ◽  
M Buchfelder ◽  
M Reincke ◽  
C M Strasburger ◽  
H Franz ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Treatment Outcomes ◽  
Surgical Outcome ◽  
Pituitary Surgery ◽  
Somatostatin Analog ◽  
Pituitary Insufficiency ◽  
Debulking Surgery ◽  
Large Tumor ◽  
Primary Surgery ◽  
Post Surgery

BackgroundData on surgical and medical treatment outcomes in acromegaly mostly originate from specialized centers. We retrospectively analyzed the data on surgery, primary somatostatin analog (SSA) therapy, surgery preceded by SSA, and SSA preceded by surgery in 1485 patients from the German Acromegaly Register.MethodsTwo trained nurses visited all centers (N=42) for data acquisition.ResultsPrimary surgery: out of 889 patients, 554 yielded analyzable data (microadenomas 22.9%, macroadenomas 77.1%). GH and IGF1 normalized in 54.3 and 67.2%. Partial or total pituitary insufficiency occurred in 28.6% initially and 41.2% post-surgery. Primary SSA (≥3 months): out of 329 patients, 145 yielded analyzable data (microadenomas 26.7%, macroadenomas 73.3%). GH and IGF1 normalized in 36.3 and 30.5%, increasing to 40.8 and 41.5% with longer SSA (≥360 days) in 54 patients. Pituitary function did not change. SSA (≥3 months) prior to surgery: out of 234 patients, 93 yielded analyzable data. Post-surgery GH and IGF1 was normalized in 62.9 and 68.4%. GH improvement was slightly, but significantly better after SSA pretreatment. Surgery followed by SSA: out of 122 patients, 34 yielded analyzable data. GH and IGF1 normalized during SSA in 24.1 and 45.5%. Relative GH decrease was significantly larger compared with primary SSA.ConclusionsPituitary surgery was more effective to lower GH and IGF1 concentrations than primary SSA. Primary SSA may be an option in selected patients. SSA prior to surgery only marginally improved surgical outcome. Debulking surgery may result in better final outcome in patients with a high GH concentration and a large tumor.

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