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.

scholarly journals Iatrogenic Ureterovaginal Fistulae: Difficulties in Diagnosis and Treatment in Our Case series

2019 ◽  
pp. 01-06
Author(s):  
Cristina Palmer, DO ◽  
Bilal Farhan, MD ◽  
Gamal Ghoniem, MD FACS
Keyword(s):  
Case Series ◽  
Ureteral Injury ◽  
Pelvic Surgery ◽  
Fistula Formation ◽  
Gynecologic Surgery ◽  
Ureterovaginal Fistula ◽  
Vaginal Cuff ◽  
Ureterovesical Junction ◽  
Ureteral Injuries ◽  
Damage Risk

Ureteral injury is a known complication of pelvic surgeries, including gynecological, urologic, colorectal, and vascular surgeries. This can occur by transvaginal, laparoscopic, or transabdominal approach [1,2]. Gynecological surgery remains by far the most common means of injury (75%), followed by colorectal surgeries (14%) [3-5], with reports of ureteral injury during gynecologic surgery from 0.35% to 1.5% [4,6]. Total abdominal and laparoscopic hysterectomies are the most common procedures where ureteral injury occurs [1,5]. Injury occurs most often at the level where the ureter courses under the uterine vessels, followed by the ureterovesical junction and the base of the infundibulopelvic ligament [4,7,8]. Many ureteral injuries occur during uncomplicated, routine surgery [8,9]. An abnormal connection between the ureter and vagina, or ureterovaginal fistula, allows for a conduit through which urine can continually leak. This is specific to the combination of ureteral injury and hysterectomy where the urine finds its way to the freshly closed vaginal cuff. Genitourinary fistula formation remains one of the most feared complications of pelvic surgery, with lasting emotional damage, risk for infections, infertility, reoperation, and increased hospital stay [5,10]. Our objective is to present the difficulties encountered in management of our cases and how to rectify them.

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. .

Ureteral injury discovered after pelvic surgery

1962 ◽  
Vol 83 (3) ◽  
pp. 406-409 ◽  
Author(s):  
Vincent C. Freda ◽  
Derek Tacchi
Keyword(s):  
Ureteral Injury ◽  
Pelvic Surgery

scholarly journals Ureteral realignment with combined access as a treatment of complete ureteral transection

2019 ◽  
Vol 91 (3) ◽  
Author(s):  
Jorge Panach-Navarrete ◽  
Marcos Antonio Lloret-Durà ◽  
María Medina-González ◽  
José María Martínez-Jabaloyas
Keyword(s):  
Treatment Option ◽  
Reconstructive Surgery ◽  
Alternative Treatment ◽  
Standard Treatment ◽  
Ureteral Injury ◽  
Urinary System ◽  
Subsequent Evolution ◽  
Injured Area ◽  
The One

Ureteral realignment using a ureteral stent can be an alternative treatment in cases of complete ureteral transection and may avoid the need for reconstructive surgery. The combined access can help the passage of the guidewire through the injured area and the threading of the urinary system of the patient. We present a case of a 38-year-old man with multiples abdominal surgeries, who underwent a complete ureteral section treated with ureteral realignment with combined access. The subsequent evolution was favourable, with resolution of the ureteral injury at the acute time, and without the presence of long-term obstruction. Although we must accept that the standard treatment of the complete ureteral transection is reconstruction and anastomosis, in cases such as the one prsented, with multiple abdominal surgeries and whenever it is technically feasible, ureteral realignment may be a treatment option.

scholarly journals Urethrovaginal fistula repair with or without concurrent fascial sling placement: A retrospective review

2020 ◽  
Vol 15 (5) ◽  
Author(s):  
Sarah Neu ◽  
Jennifer Locke ◽  
Mitchell Goldenberg ◽  
Sender Herschorn
Keyword(s):  
Patient Characteristics ◽  
Urethral Diverticulum ◽  
Pelvic Surgery ◽  
Study Patient ◽  
Complication Rates ◽  
Urethrovaginal Fistula ◽  
Fascial Sling ◽  
Significant Difference ◽  
Sling Placement

Introduction: We sought to review outcomes of urethrovaginal fistula (UVF) repair, with or without concurrent fascial sling placement. Methods: All patients diagnosed with UVF at our center from 1988–2017 were included in this study. Patient charts were reviewed from a prospectively kept fistula database, and patient characteristics and surgical outcomes were described. Descriptive statistics were applied to compare complication rates between patients with or without fascial sling placement at the time of UVF repair. Results: A total of 41 cases of UVF were identified, all of which underwent surgical repair. Median age at diagnosis was 49 years (interquartile range [IQR] 35–62). All patients had undergone pelvic surgery. UVF etiology was secondary to stress urinary incontinence (SUI) surgery in 17 patients (41%) and urethral diverticulum repair in seven patients (17%). The most common presenting symptom was continuous incontinence in 19 patients (46%). Nineteen patients had a fascial sling placed at the time of surgery (46%), with no significant difference in complication rates (26% vs. 23%, p=0.79). Two patients had Clavien-Dindo grade I complications (5%) and one had a grade III complication (2%). Four patients had long-term complications (10%), including urinary retention, chronic pain, and urethral stricture. Two patients had UVF recurrence (5%). Median followup after surgery was 21 months (IQR 4–72). Conclusions: UVF should be suspected in patients with continuous incontinence following a surgical procedure. Most UVF surgical repairs are successful and can be done with concurrent placement of a fascial sling.

scholarly journals Effects of Donepezil on Extrapyramidal Symptoms in Patients with Dementia with Lewy Bodies: A Secondary Pooled Analysis of Two Randomized-Controlled and Two Open-Label Long-Term Extension Studies

2015 ◽  
Vol 40 (3-4) ◽  
pp. 186-198 ◽  
Author(s):  
Etsuro Mori ◽  
Manabu Ikeda ◽  
Masaki Nakagawa ◽  
Hideaki Miyagishi ◽  
Hideo Yamaguchi ◽  
...  
Keyword(s):  
Dementia With Lewy Bodies ◽  
Rating Scale ◽  
Multivariate Logistic Regression Analysis ◽  
Lewy Bodies ◽  
Pooled Analysis ◽  
Extrapyramidal Symptoms ◽  
Open Label ◽  
Predisposing Factor ◽  
Baseline Severity

Background/Aims: The aim of this study was to clarify the effects of donepezil on extrapyramidal symptoms in patients with dementia with Lewy bodies (DLB). Methods: Using pooled datasets from phase 2 and 3, 12-week randomized, placebo-controlled trials (RCT, n = 281) and 52-week open-label long-term extension trials (OLE, n = 241) of donepezil in DLB, the effects of donepezil on the incidence of extrapyramidal adverse events (AEs) and on the Unified Parkinson's Disease Rating Scale (UPDRS) part III were assessed, and potential baseline factors affecting the AEs were explored. Results: The RCT analysis did not show significant differences between the placebo and active (3, 5, and 10 mg donepezil) groups in extrapyramidal AE incidence (3.8 and 6.5%, p = 0.569) and change in the UPDRS (mean ± SD: -0.2 ± 4.3 and -0.6 ± 6.5, p = 0.562). In the OLE analysis (5 and 10 mg donepezil), the incidence did not increase chronologically; all AEs leading to a dose reduction or discontinuation except one were relieved. The UPDRS was unchanged for 52 weeks. An exploratory multivariate logistic regression analysis of the RCTs revealed that donepezil treatment was not a significant factor affecting the AEs. Baseline severity of parkinsonism was a predisposing factor for worsening of parkinsonism without significant interactions between donepezil and baseline severity. Conclusion: DLB can safely be treated with donepezil without relevant worsening of extrapyramidal symptoms, but treatment requires careful attention to symptom progression when administered to patients with relatively severe parkinsonism.

A Review of Pramlintide in the Management of Diabetes

2009 ◽  
Vol 1 ◽  
pp. CMT.S2369
Author(s):  
Caroline Messer ◽  
Dina Green
Keyword(s):  
Microvascular Complications ◽  
Effective Means ◽  
Postprandial Glucose ◽  
Tight Glycemic Control ◽  
Minimal Risk ◽  
Patients With Diabetes ◽  
Insulin Dependent

Tight glycemic control in type 1 and type 2 diabetes reduces the risk for microvascular complications, including retinopathy, nephropathy, and neuropathy. Yet, despite intensive insulin regimens, many insulin-dependent patients are unable to achieve euglycemic states. This review will focus on pramlintide, an equipotent amylin analog, and its role in the management of diabetes. Pramlintide lowers glucose through the same mechanisms as amylin: it slows gastric emptying, suppresses the postprandial rise of glucagon in patients with diabetes, and promotes satiety. Long-term clinical trials have shown that the use of pramlintide as an adjunct to insulin minimizes postprandial glucose excursions and reduces both HbA1C and body weight when compared to placebo. Although its effects on HbA1C are modest, pramlintide has gained popularity as a result of its relatively few contraindications, limited side effects, minimal risk for hypoglycemia, and potential for weight loss. The combination of insulin and pramlintide may provide an effective means for patients with diabetes to meet their HbA1C goals.

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