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 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.

Frequency of Lower Urinary Tract Injury after Gastrointestinal Surgery in the Nationwide Inpatient Sample Database

2014 ◽  
Vol 80 (12) ◽  
pp. 1216-1221 ◽  
Author(s):  
Hari P. Sawkar ◽  
Dae Y. Kim ◽  
D. Joseph Thum ◽  
Lee Zhao ◽  
John Cashy ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Large Bowel ◽  
Lower Urinary Tract ◽  
Nationwide Inpatient Sample ◽  
Gastrointestinal Surgery ◽  
Ureteral Injury ◽  
Pelvic Surgery ◽  
Gynecologic Surgery ◽  
Bladder Injury ◽  
Lower Urinary

Bladder and ureteral injury are serious iatrogenic complications during abdominal and pelvic surgery but are poorly investigated in the general surgery literature. The objective of this study was to examine rates, trends, and patient and surgical characteristics present in lower urinary tract injuries during gastrointestinal surgery using the Nationwide Inpatient Sample (NIS) database. The NIS database was queried from 2002 to 2010 for gastrointestinal surgery procedures including small/large bowel, rectal surgery, and procedures involving a combination of the two. These were crossreferenced with bladder and ureteral injury using International Classification of Diseases, 9th Revision, Clinical Modification codes. Multivariate regression analysis was used to calculate odds ratios for hypothesized risk factors. From 2002 to 2010, total average rates of bladder injury and ureteral injury were 0.15 and 0.06 per cent, respectively. Small/large bowel procedures had lower annual rates of ureteral (0.05 to 0.07%) and bladder (0.12 to 0.14%) injuries compared with ureteral (0.11 to 0.25%) and bladder (0.27 to 0.41%) injuries in rectal procedures. Presence of metastatic disease was associated with the greatest risk for bladder (odds ratio, 2.0; 95% confidence interval, 1.8 to 2.2) and ureteral (2.2; 1.9 to 2.5) injury in small/large bowel surgery, and for bladder (3.1; 2.5 to 3.9) and ureteral (4.0; 3.2 to 5.0) injury in combination procedures. Injury rates were significantly greater in open surgeries compared with laparoscopic procedures for both bladder injury (0.78 vs 0.26%, P < 0.0001) and ureteral injury (0.34 vs 0.06%, P < 0.0001). The incidence of genitourinary (GU) injury in gastrointestinal surgery is rare, less than 1.0 per cent, and is less than the incidence of GU injury reported in gynecologic surgery. This risk is increased by operations on the rectum and the presence of malignancy.

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 Pelvic Surgical Site Infections in Gynecologic Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Mark P. Lachiewicz ◽  
Laura J. Moulton ◽  
Oluwatosin Jaiyeoba
Keyword(s):  
Risk Factors ◽  
Surgical Site Infections ◽  
Pelvic Surgery ◽  
Gynecologic Surgery ◽  
Pathogenic Microorganisms ◽  
Common Complication ◽  
Vaginal Cuff ◽  
Unique Challenge ◽  
Gynecologic Surgical Procedures ◽  
Patient Morbidity

The development of surgical site infection (SSI) remains the most common complication of gynecologic surgical procedures and results in significant patient morbidity. Gynecologic procedures pose a unique challenge in that potential pathogenic microorganisms from the skin or vagina and endocervix may migrate to operative sites and can result in vaginal cuff cellulitis, pelvic cellulitis, and pelvic abscesses. Multiple host and surgical risk factors have been identified as risks that increase infectious sequelae after pelvic surgery. This paper will review these risk factors as many are modifiable and care should be taken to address such factors in order to decrease the chance of infection. We will also review the definitions, microbiology, pathogenesis, diagnosis, and management of pelvic SSIs after gynecologic surgery.

scholarly journals Avascular Spaces of the Female Pelvis—Clinical Applications in Obstetrics and Gynecology

2020 ◽  
Vol 9 (5) ◽  
pp. 1460
Author(s):  
Stoyan Kostov ◽  
Stanislav Slavchev ◽  
Deyan Dzhenkov ◽  
Dimitar Mitev ◽  
Angel Yordanov
Keyword(s):  
Pelvic Surgery ◽  
Gynecologic Surgery ◽  
Obstetrics And Gynecology ◽  
Nerve Sparing ◽  
Clinical Anatomy ◽  
Anatomical Landmarks ◽  
Female Pelvis ◽  
Precise Understanding ◽  
Significant Difference ◽  
Gynecological Diseases

The term “spaces” refers to the areas delimited by at least two independent fasciae and filled with areolar connective tissue. However, there is discrepancy regarding the spaces and their limits between clinical anatomy and gynecologic surgery, as not every avascular space described in literature is delimited by at least two fasciae. Moreover, new spaces and surgical planes have been developed after the adoption of laparoscopy and nerve-sparing gynecological procedures. Avascular spaces are useful anatomical landmarks in retroperitoneal anatomic and pelvic surgery for both malignant and benign conditions. A noteworthy fact is that for various gynecological diseases, there are different approaches to the avascular spaces of the female pelvis. This is a significant difference, which is best demonstrated by dissection of these spaces for gynecological, urogynecological, and oncogynecological operations. Thorough knowledge regarding pelvic anatomy of these spaces is vital to minimize morbidity and mortality. In this article, we defined nine avascular female pelvic spaces—their boundaries, different approaches, attention during dissection, and applications in obstetrics and gynecology. We described the fourth space and separate the paravesical and pararectal space, as nerve-sparing gynecological procedures request a precise understanding of retroperitoneal spaces.

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 Pulmonary benign metastasizing leiomyomas: a case series of 23 patients at a single facility

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rong Fan ◽  
Fengzhi Feng ◽  
Hua Yang ◽  
Kaifeng Xu ◽  
Shanqing Li ◽  
...  
Keyword(s):  
Rare Disease ◽  
Single Case ◽  
Case Series ◽  
Progesterone Receptors ◽  
Complete Response ◽  
Gynecologic Surgery ◽  
Curative Surgery ◽  
College Hospital ◽  
First Choice ◽  
S 100

Abstract Background Pulmonary benign metastasizing leiomyoma (PBML) is a rare disease characterized by leiomyoma of benign histopathology existing in the lungs. Because of its rarity, limited literature with a single case or small number of cases has been regarding to the clinical course, pathology or management of PBML. Methods A retrospective study was performed of all PBML cases diagnosed and managed at Peking Union Medical College Hospital (PUMCH) from 2001 to 2019. The clinical characteristics, pathology, treatment and outcomes of each case were studied. Results There were 25 PBML patients identified in the 19-year period in PUMCH, and 23 patients’ data was analyzed. The median age at diagnosis was 46 years. There were 7 patients (30.4%) diagnosed with postmenopausal status. Two patients (8.7%) had no uterine leiomyoma, and 3 patients (13.0%) had no gynecologic surgery history. Immunohistochemistry of most lesions demonstrated positive for desmin, SMA and Estrogen/Progesterone Receptors; and negative for S-100 were shown in 7 cases. After curative or diagnostic surgeries for the PBML, several treatments from observation to medical or surgical castration were performed. Nine premenopausal patients preserved their ovaries at first. At a median follow-up of 8 years, 3 patients finally had oophorectomy. Conclusions PBML is a rare disease and should be treated by individualization according to the patients’ age, symptoms and extent of lesion. Curative surgery for patients with limited lesions can achieve the complete response. For patients that are young and asymptomatic, close observation is recommended as the first choice. All patients should undergo long-term surveillance.

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