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.

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 Post Abdominal Hysterectomy Ureterovaginal Fistula

2018 ◽  
Vol 13 (2) ◽  
pp. 58-59
Author(s):  
Kanti Prabha Giri ◽  
Ganesh Dangal ◽  
Aruna Karki ◽  
Hema Pradhan ◽  
Ranjana Shrestha ◽  
...  
Keyword(s):  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Surgical Skill ◽  
Pelvic Anatomy ◽  
Ureterovaginal Fistula ◽  
Ureteric Injury ◽  
Common Cause ◽  
Dj Stent ◽  
Ct Urogram ◽  
The Common

Ureteric injury can occur during any pelvic or abdominal surgeries. Gynecological surgeries especially total abdominal hysterectomy is one of the common cause of iatrogenic ureteric injury leading to ureterovaginal fistula. A 35 years lady had continuous leaking of urine per vagina from 25th day after total abdominal hysterectomy. Her CT urogram showed left distal ureterovaginal fistula and she underwent left ureteroneocystostomy. A good knowledge of pelvic anatomy is necessary along with a good surgical skill to prevent ureteric injury during surgery. Keywords: DJ stent, ureteric injury, ureterovaginal fistula.

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.

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 An Alternative Loop Snare Technique with Many Loops Using a Simple Guide-Wire for Removal of a Double J Stent: A Case Series

2020 ◽  
Vol 17 (3) ◽  
Author(s):  
Su Ho Kim ◽  
Byung Gil Choi ◽  
Oh Jung Suk ◽  
Ho Jong Chun ◽  
Hae Giu Lee
Keyword(s):  
Guide Wire ◽  
Bladder Wall ◽  
Case Series ◽  
Fluoroscopic Guidance ◽  
Difficult Patients ◽  
Stent Removal ◽  
Background Removal ◽  
Double J Stent ◽  
Dj Stent ◽  
Loop Snare

Background: Removal of a double J (DJ) stent has been conventionally performed with conventional snare wires, tissue forceps, or stone baskets under fluoroscopic guidance. However, if the lumen is collapsed, is very wide, or if the tip of the DJ stent is lodged in the bladder wall, the procedure becomes difficult. Patients and Methods: We retrospectively reviewed four patients who had undergone retrieval or replacement of their DJ stents by interventional radiologists with an alternative loop snare technique using a guide-wire after conventional attempts using a snare catheter had failed. Results: Five DJ stents were completely removed without any complications. Conclusion: The loop snare technique using a guide-wire could be an alternative and inexpensive approach for difficult DJ stent removal.

scholarly journals A Giant Ureteral Stone without Underlying Anatomic or Metabolic Abnormalities: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Selcuk Sarikaya ◽  
Berkan Resorlu ◽  
Ekrem Ozyuvali ◽  
Omer Faruk Bozkurt ◽  
Ural Oguz ◽  
...  
Keyword(s):  
Ureteral Stone ◽  
Ammonium Phosphate ◽  
Intravenous Urography ◽  
Metabolic Abnormalities ◽  
Magnesium Ammonium Phosphate ◽  
Distal Ureter ◽  
Double J Stent ◽  
Magnesium Ammonium ◽  
Left Flank Pain ◽  
Plain Abdominal Film

A 28-year old man presented with left flank pain and dysuria. Plain abdominal film and computed tomography showed a left giant ureteral stone measuring 11.5 cm causing ureteral obstruction and other stones 2.5 cm in size in the lower pole of ipsilateral kidney and 7 mm in size in distal part of right ureter. A left ureterolithotomy was performed and then a double J stent was inserted into the ureter. The patient was discharged from the hospital 4 days postoperatively with no complications. Stone analysis was consistent with magnesium ammonium phosphate and calcium oxalate. Underlying anatomic or metabolic abnormalities were not detected. One month after surgery, right ureteral stone passed spontaneously, left renal stone moved to distal ureter, and it was removed by ureterolithotomy. Control intravenous urography and cystography demonstrated unobstructed bilateral ureter and the absence of vesicoureteral reflux.

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 Novel insights into fecal incontinence in men

2017 ◽  
Vol 312 (1) ◽  
pp. G46-G51 ◽  
Author(s):  
Yoav Mazor ◽  
Michael Jones ◽  
Alison Andrews ◽  
John E. Kellow ◽  
Allison Malcolm
Keyword(s):  
Sex Differences ◽  
Fecal Incontinence ◽  
Clinical Features ◽  
Successful Outcome ◽  
Biofeedback Therapy ◽  
Tertiary Referral ◽  
Future Studies ◽  
Tertiary Referral Center ◽  
Rectal Pressure

Fecal incontinence (FI) in men is common, yet data on sex differences in clinical features, physiology, and treatment are scarce. Our aim was to provide insights into FI in males compared with females. Prospectively collected data from 73 men and 596 women with FI in a tertiary referral center were analyzed. Anorectal physiology, clinical characteristics, and outcome of instrumented biofeedback (BF) were recorded. Thirty-one men with FI proceeded to BF and were matched with 62 age-matched women with FI who underwent BF. Men with FI had higher resting, squeeze, and cough anal sphincter pressures ( P < 0.001) and were more able to hold a sustained squeeze compared with women ( P = 0.04). Men with FI had higher rectal pressure and less inadequate rectal pressure on strain and higher sensory thresholds ( P < 0.05). Men, but not women, with isolated soiling had higher anal resting and squeeze pressures compared with those with overt FI ( P < 0.05). Men were less likely to undergo BF when offered compared with women. Baseline symptom severity did not differ between the groups. In men, the absence of an organic cause for the FI and the presence of overt FI, but not isolated soiling, were correlated with improvement in patient satisfaction following BF. The outcomes of 50% reduction in FI episodes, physician assessment, symptoms, and quality of life scores after BF all significantly improved in men similarly to women. We conclude that men, compared with women, with FI have unique clinical features and physiology and are less likely to have investigations and treatment despite successful outcome with BF. Future studies to customize treatment in males and determine barriers to therapy are warranted. NEW & NOTEWORTHY Fecal incontinence in men is common, yet data on sex differences in clinical features, physiology, and treatment are scarce. We provide evidence that men, compared with women, with fecal incontinence have unique clinical features and physiology and are less likely to have investigations and treatment despite successful outcome with anorectal biofeedback therapy.

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 Feasibility of minimally invasive management in patients with forgotten double J stent: a single centre experience

2019 ◽  
Vol 8 (1) ◽  
pp. 37
Author(s):  
Mohd Hamid Shafique Ahmed ◽  
Harshad Toshniwal ◽  
Prakash W. Pawar ◽  
Ajit S. Sawant ◽  
Amandeep Arora ◽  
...  
Keyword(s):  
Renal Function ◽  
Urinary Tract ◽  
Surgical Techniques ◽  
Presenting Symptoms ◽  
Double J Stent ◽  
Urinary Tract Symptoms ◽  
Single Centre Experience ◽  
Dj Stent ◽  
History Of ◽  
Tract Infections

Background: aim of the study was to present the experience in managing forgotten/encrusted Double J (DJ) ureteral stents and to review the literature on the subject.Methods: Author retrospectively studied patients presenting to the Outpatient Department from January 2016 to January 2019 with forgotten DJ stent(s) (six or more than six months after the insertion). Data was collected for age, gender, indication for DJ stenting, clinical features at presentation, radiological imaging and surgical procedure performed to extract the DJ stents. The post-operative stay, complications of the procedures and morbidity was also studied.Results: During the study period, a total 32 patients reported to the department with history of forgotten DJ stents. Most common age group involved was 41-60 years. Most common presenting symptoms were lower urinary tract symptoms (LUTS) or dysuria.  Duration of stent in-situ ranged from 6 month to 15 years. Most common sites of encrustations along the forgotten DJ stent were ureter and kidney followed by urinary blabber. Fluoroscopic guided DJ stent removal was done in 8 patients. A combination of Cystolithotripsy, URSL and PCNL was needed to clear the stone and extract the DJ stent in remaining patients.Conclusions: Forgotten/encrusted DJ stent may lead to complications ranging from urinary tract infections to loss of renal function. They can be safely and successfully removed, and the renal function can be preserved. Endo-urological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.

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