Diagnostic and Interventional Radiology Management of Ureteral Iatrogenic Leakage after Gynecologic Surgery

Objective: To report safety and efficacy of interventional radiology procedures in the treatment of gynecologic iatrogenic urinary leaks. Methods: A retrospective analysis of iatrogenic ureteral lesions treated between November 2009 to April 2019 was performed. Under ultrasound (US) and fluoroscopy guidance, an attempt to place a ureteral stent and nephrostomy was carried out in the same session using an anterograde percutaneous approach. At the end of any procedure, a fluoroscopic control and a cone-beam CT scan (CBCT) were performed to check the correct placement and functioning of the nephrostomy and DJ stent. In cases of difficult ureteral stent placement via the single anterograde approach, the collaboration of urologists was requested to perform a rendezvous technique, combined with the retrograde approach. Results: DJ stent placement was achieved using the anterograde approach in 12/15 (80.0%) patients and using the retrograde approach in 3/15 cases (20.0%). Moreover, in 3/15 (20.0%) patients, surgical treatment was needed: in one case because of the persistence of ureteral stenosis at 6 months, and in the other two cases due to ureter-vaginal fistula. No major complications were recorded; overall, minor complications occurred in 4/8 patients. Conclusion: Percutaneous minimally invasive treatment of iatrogenic ureteral lesions after gynecological surgery is a safe and effective option.

Download Full-text

Percutaneous Transcollateral Retrograde Recanalization of Isolated Dissection of the Superior Mesenteric Artery

Vascular and Endovascular Surgery ◽

10.1177/1538574419877618 ◽

2019 ◽

Vol 54 (1) ◽

pp. 89-92

Author(s):

Yung Hsu ◽

Hua-Ming Cheng ◽

Reng-Hong Wu

Keyword(s):

Superior Mesenteric Artery ◽

Stent Placement ◽

Mesenteric Artery ◽

Middle Colic Artery ◽

Colic Artery ◽

Endovascular Stent ◽

Retrograde Approach ◽

Transfemoral Approach ◽

Rendezvous Technique ◽

Endovascular Stent Placement

Endovascular stent placement (ESP) for patient with spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a widely accepted treatment option. However, failed percutaneous ESP is not uncommon and is one of the leading causes for laparotomy. We report a case of 63-year-old man with SIDSMA encountered failed antegrade recanalization via conventional transfemoral approach. We achieved recanalization in a retrograde fashion through middle colic artery using rendezvous technique and successfully placed self-expandable stents inside the dissected superior mesenteric artery. The patient recovered well after percutaneous ESP. We herein describe the transcollateral retrograde approach of percutaneous ESP for SIDSMA as an alternative option when conventional antegrade recanalization fails.

Download Full-text

Efficacy of Tamsulosin in relieving double-J stent-related symptoms: a randomized controlled study

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v18i3.15301 ◽

2016 ◽

Vol 18 (3) ◽

pp. 38 ◽

Cited By ~ 1

Author(s):

DK Thakur ◽

S Chapagain ◽

BR Luitel ◽

PR Chalise ◽

UK Sharma ◽

...

Keyword(s):

Quality Of Life ◽

Stent Placement ◽

Ureteral Stent ◽

Controlled Study ◽

Control Group ◽

Stent Removal ◽

Double J Stent ◽

Dj Stent ◽

And Control

Introduction: Ureteral stent placement is an increasingly common procedure in urological practice.They are used for both prevention and treatment of ureteral obstruction. Despite improved design and materials, many patients still develop stent-related symptoms which commonly affect quality of life and sometimes necessitate early removal. Tamsulosin improves stent-related symptoms and quality of life, and can be applied in routine clinical practice. In the present study, the effect of Tamsulosin in improving double-J stent-related symptoms and quality of life following ureteral stent placement was studied.Methods: This RCT was carried out in the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from February 2015 to January 2016. Forty six patients were included in the study and randomized into Tamsulosin(T) group and Control(C) group each having 23 patients. In addition to standard postoperative care, Tamsulosin group received 0.4mg Tamsulosin daily and Paraceramol on demand and control group received only Paracetamol. Stent related symptoms and quality of life was assessed by IPSS at discharge (day2) and at the time of DJ stent removal (2 weeks). Pain was evaluated by VAS and analgesic requirement was documented. Data were analysed using SPSS 20, chi-square test and Student’s t- test was used. A p-value of <0.05 was considered significant.Results: Mean age in Tamsulosin group was 37.96±12.98 and Control group 36.43± 10.99(p=0.67).There was no significant difference in IPSS(p=0.141), QoL index (p=0.089) and VAS (p=0.59) in the two groups at the time of discharge.At the time of DJ stent removal, IPSS (p<0.001), QoL index (p<0.001), VAS (p=0.004) and analgesic needed (p<0.001) was significantly lower in T group than in C group.Conclusion: Tamsulosin lowers stent related symptoms, pain and improves quality of life in patients with indwelling DJ stent though the effect is not immediate.

Download Full-text

Is Ureteral Stent Placement by the Transurethral Approach During Robot-Assisted Radical Prostatectomy an Effective Option to Preoperative Technique?

Journal of Endourology ◽

10.1089/end.2014.0061 ◽

2014 ◽

Vol 28 (8) ◽

pp. 896-898 ◽

Cited By ~ 1

Author(s):

Alberto Molinari ◽

Giovanni Simonelli ◽

Bernardino De Concilio ◽

Antonio Benito Porcaro ◽

Dario Del Biondo ◽

...

Keyword(s):

Radical Prostatectomy ◽

Stent Placement ◽

Ureteral Stent ◽

Robot Assisted ◽

Effective Option

Download Full-text

Efficacy of Tamsulosin in Relieving Double-J Stentrelated Symptoms: a Randomized Controlled Study

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v19i2.24541 ◽

2016 ◽

Vol 19 (2) ◽

pp. 3-6

Author(s):

Deepak K Thakur ◽

Suman Chapagain ◽

Bhojraj Luitel ◽

Pawan Raj Chalise ◽

Uttam Kumar Sharma ◽

...

Keyword(s):

Quality Of Life ◽

Stent Placement ◽

Ureteral Stent ◽

Controlled Study ◽

Control Group ◽

Stent Removal ◽

Significant Difference ◽

Dj Stent ◽

And Control

Introduction: Ureteral stent placement is an increasingly common procedure in urological practice. They are used for both prevention and treatment of ureteral obstruction. Despite improved design and materials, many patients still develop stent-related symptoms which commonly affect quality of life and sometimes necessitate early removal. Tamsulosin improves stent-related symptoms and quality of life. But such study has not been conducted in Nepalese context. In the present study, the effect of Tamsulosin in improving double-J stent-related symptoms and quality of life following ureteral stent placement was studied. Methods: This study was carried out in the Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from February 2015 to January 2016. Forty six patients were included in the study and randomized into Tamsulosin (T) group and Control (C) group each having 23 patients. In addition to standard postoperative care, Tamsulosin group received 0.4 mg Tamsulosin daily for 2 weeks and Paracetamol on demand and control group received only Paracetamol (1gram/dose). Stent related symptoms and quality of life was assessed by International prostate symptom score (IPSS) at discharge (day2) and at the time of DJ stent removal (2 weeks). Pain was evaluated by visual analog scale (VAS) and analgesic requirement was documented. Data were analysed using Statistical Package for the Social Sciences (SPSS) 20, chisquare test and Student’s t- test was used. A p-value of <0.05 was considered significant. Results: Mean age in Tamsulosin group was 37.96±12.98 years and Control group 36.43± 10.99 years (p=0.67).There was no significant difference in IPSS (p=0.141), QoL index (p=0.089) and VAS (p=0.59) in the two groups at the time of discharge. At the time of DJ stent removal, IPSS (p<0.001), QoL index(p<0.001), VAS(p=0.004) and analgesic needed(p<0.001) was significantly lower in T group than in C group. Conclusion: Tamsulosin lowers stent related symptoms, pain and improves quality of life in patients with indwelling DJ stent though the effect is not immediate.

Download Full-text

Combined Antegrade and Retrograde Approach in Iatrogenic Ureteral Injuries: The Rendezvous Technique

10.1055/s-0041-1730536 ◽

2019 ◽

Author(s):

Pacella Giuseppina ◽

Faiella Eliodoro ◽

Santucci Domiziana ◽

Grasso Rosario Francesco ◽

Beomonte Zobel Bruno

Keyword(s):

Retrograde Approach ◽

Rendezvous Technique ◽

Ureteral Injuries

Download Full-text

Parallel Second Stent Placement for Refractory Ureteral Stent Malfunction in Malignant Ureteral Obstruction

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2011.02.038 ◽

2011 ◽

Vol 22 (7) ◽

pp. 1012-1016 ◽

Cited By ~ 11

Author(s):

Hung-Chieh Chen ◽

Shu-Huei Shen ◽

Jia-Hwia Wang ◽

William J.S. Huang ◽

Hsiou-Shan Tseng ◽

...

Keyword(s):

Stent Placement ◽

Ureteral Obstruction ◽

Ureteral Stent ◽

Malignant Ureteral Obstruction

Download Full-text

Temporary Covered Metallic Ureteral Stent Placement for Ureteral Strictures following Kidney Transplantation: Experience in 8 Patients

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2020.04.004 ◽

2020 ◽

Vol 31 (11) ◽

pp. 1795-1800

Author(s):

Chuanwu Cao ◽

Jong-Woo Kim ◽

Ji Hoon Shin ◽

Maoqian Li ◽

Bumsik Hong ◽

...

Keyword(s):

Kidney Transplantation ◽

Stent Placement ◽

Ureteral Stent

Download Full-text

Rendezvous for afferent limb syndrome

Clinical Medical Reviews and Reports ◽

10.31579/2690-8794/049 ◽

2020 ◽

Vol 2 (9) ◽

pp. 01-04

Author(s):

Ivan Mendez

Keyword(s):

Pancreatic Cancer ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Stent Placement ◽

Whipple Procedure ◽

Metallic Stent ◽

Biliary Anatomy ◽

Endoscopic Retrograde ◽

Afferent Limb ◽

Rendezvous Technique ◽

Metallic Stent Placement

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgical alterations in the normal biliary anatomy is technically challenging. We describe the case of a 73-year-old patient with an afferent limb syndrome secondary to a Whipple procedure for pancreatic cancer, in which a percutaneous rendezvous technique assisted in the endoscopic metallic stent placement with favorable outcome.

Download Full-text