scholarly journals Ureteric Injury in Gynecology Surgery

2021 ◽  
Author(s):  
Rama Garg
Keyword(s):  
Urinary Tract ◽  
Fluid Collection ◽  
Signs And Symptoms ◽  
Ureteral Injury ◽  
Pelvic Surgery ◽  
Absorbable Suture ◽  
Ureteric Injury ◽  
Systematic Assessment ◽  
Free Closure ◽  
Rigid Instruments

It is the most serious and trouble-some complication of pelvic surgery and common reason for medico-legal action by the patient. It can be unilateral or bilateral. Lowest 3 cm of ureter is usually injured. 75% of injuries result from gynecological operations - 3/4th during abdominal and 1/4th during vaginal operations. As most injuries can be diagnosed intraoperatively, systematic assessment of urinary tract integrity should be part of the surgical plan. Intraoperative cystoscopy using either flexible or rigid instruments can aid in the diagnosis or exclusion of urinary tract injury. Identification of the mechanism of injury and its location guides immediate or delayed repair. Mobilization should be sufficient to allow a tension-free closure. Tissue interposition is typically recommended. Common sites for ureteral injury are found beneath the uterine vessels near the cardinal ligament and beneath the infundibulopelvic ligament and the tunnel of Wertheim. Successful ureteral repair relies on careful mobilization, wide spatulation, use of fine absorbable suture (4-0, 5-0), and temporary stenting. Postoperative signs and symptoms of ureteral injury may include unilateral flank pain, fever, prolonged ileus, and abdominal or pelvic fluid collection (urinoma).

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.

Urogenital Fistulas and Female Urethral Diverticula

2020 ◽  
Author(s):  
Lindsey Cox ◽  
Eric S. Rovner
Keyword(s):  
Urinary Tract ◽  
Surgical Techniques ◽  
Signs And Symptoms ◽  
Urethral Diverticulum ◽  
Vascular Supply ◽  
Organ System ◽  
Fistula Tract ◽  
Urethrovaginal Fistula ◽  
Urogenital Fistula ◽  
Tract Fistula

Urogenital fistulas are a group of conditions in which the urinary tract is apparently connected to another organ system. Causes of fistula range from congenital anomalies, malignancy, trauma, infection or inflammatory conditions, ischemia, parturition, and iatrogenic sources – including surgery and radiation. Signs and symptoms of urinary tract fistula are variable and depend on the organ system involved and the size of the fistula. For patients who are appropriate surgical candidates, elective surgical repair is the mainstay of treatment of urinary tract fistula. Surgical techniques can be complex, but rely on the same key concepts: adequate exposure of the fistula tract; careful dissection and separation of the tissue layers, while minimizing cautery; multi-layer closure; watertight closure of each layer; meticulous hemostasis to prevent hematoma formation, but preserve vascular supply of tissues; use of well-vascularized tissue flaps; tension-free, non-overlapping suture lines; biopsy of tissues concerning for malignancy. This review contains 6 figures, 5 tables, and 82 references. Keywords: urogenital fistula, female bladder, vesical fistula, urinary bladder fistula, vesicovaginal fistula, urethrovaginal fistula, vaginal fistula, urethral diverticulum, urethral diverticulectomy, female urethra

scholarly journals Clinical, Epidemiological and Bacteriological Profile of Culture Positive Urinary Tract Infections in Febrile Children – A Cross Sectional Study

2021 ◽  
Vol 8 (10) ◽  
pp. 522-526
Author(s):  
Bhavani Shankar Rokkam ◽  
Chowdary Babu Menni ◽  
Ramu Pedada ◽  
Deepak Kumar Alikana
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Signs And Symptoms ◽  
Cross Sectional ◽  
Bacteriological Profile ◽  
Tract Infections ◽  
Culture Positive

BACKGROUND Urinary tract infections (UTI) constitute a common cause of morbidity in infants and children. When associated with abnormalities of urinary tract, they may lead to long-term complications including renal scarring, loss of function and hypertension. Most urinary tract infections remain undiagnosed if investigations are not routinely performed to detect them. Prompt detection and treatment of urinary tract infections and any complicating factors are important. The objective of the study is to know the clinical, epidemiological and bacteriological profile (i.e. clinical signs and symptoms, age, sex, family history, associated urinary tract abnormalities, & causative organisms) of urinary tract infections in febrile children with culture positive urinary tract infection. METHODS This descriptive, cross sectional observational study was conducted at outpatient clinics of our “child health clinics” between May 2016 and April 2017 (one year). All children aged 0 to 12 years with culture positive urinary tract infections were included in this study to evaluate the clinical, epidemiological and bacteriological profile. RESULTS A total of 69 children with culture positive urinary tract infections were included in this study. Out of 69 children included in this study, 36 (52.2 %) were females and 33 (47.8 %) were males. Overall female preponderance was seen and the M: F ratio was 0.9:1. But during first year of life in our study group we had more boys (10, 14.49 %) affected with urinary tract infection than girls. 49.3 % of urinary tract infections in the present study belonged to lower socio-economic status. Most common organism causing urinary tract infection in our group was E. coli (56.5 %). Fever (100 %), anorexia or refusal of feeds (52.2 %), dysuria (46.4 %), vomiting (46.4 %) and abdominal pain (39.1 %) were the predominant clinical manifestations observed in our study. CONCLUSIONS Urinary tract infection is a common medical problem in children and it should be considered as a potential cause of fever in children. As febrile children with urinary tract infection usually present with non-specific signs and symptoms, urine culture should be considered as a part of diagnostic evaluation. KEYWORDS Urinary Tract Infections (UTI), Febrile Children, Bacteriological Profile, Urine Culture

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

Approach to Management of Iatrogenic Foreign Bodies of the Lower Urinary Tract Following Reconstructive Pelvic Surgery

2012 ◽  
Vol 187 (5) ◽  
pp. 1685-1690 ◽  
Author(s):  
Priya Padmanabhan ◽  
Ryan C. Hutchinson ◽  
W. Stuart Reynolds ◽  
Melissa Kaufman ◽  
Harriette M. Scarpero ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Foreign Bodies ◽  
Pelvic Surgery ◽  
Reconstructive Pelvic Surgery ◽  
Lower Urinary
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