DOUBLE J STENTING IN A DELAYED URETER INJURY DUE TO THERMAL NECROSIS FOLLOWING LAPAROSCOPIC-ASSISTED VAGINAL HYSTERECTOMY

The presenting symptom to a gynecologist for postoperative vaginal discharge, which may or may not be related to the gynecologic diagnosis. A 40-year-old woman with abnormal uterine bleeding came to ObGyn Opd. The diagnosis was simple endometrial hyperplasia for which laparoscopic assisted vaginal hysterectomy with bilateral salphingo oophorectomy was done. Post-Operative Day 18 patient developed vaginal discharge suggestive of urinary leakage. The postoperative delayed ureter injury is an unusual association with laparoscopic assisted vaginal hysterectomy. The management was ureter stent insertion. This case report could be guidance to surgeons about the postoperative management of ureter injury. Gynecologists should consider the presenting symptom of vaginal discharge in formulating their differential diagnosis.

THE RESULTS OF LAPAROSCOPIC HEMINEPHRURETERECTOMY AND URETEROPYELOANASTOMOSIS (URETEROURETEROANASTOMOSIS) FOR DUPLEX KIDNEY IN CHILDREN

Objective. To study the results of laparoscopic heminephrureterectomy (LHNE), ureteropyelostomy (LUPS) and ureteroureterostomy (LUUS) in the laparoscopic treatments of megaurete of a duplex system in children. Methods. The records of patients (n=102) who underwent LHNE and LUPS (LUUS) were retrospectively analyzed (26 (25,5%) boys and 76(74,5%) girls). The age of patients was from 3 months to 17 years (median - 17.9 months). Megaureter of the upper pole was observed in 82 (80.4%) patients, of the lower pole - in 20 (19.6%). LHNE was performed in 68 patients (66.7%), LUPA (LUUA) - in 34 (33.3%). Results. Intraoperative complications occurred in 2 patients (2.0%), conversion was required in both cases. Median operative LHNE time was 146,0±46,2 minutes (median - 120 minutes); in LUPS(LUUS) - 160,1±44,7 minutes (median - 150 minutes). One patient after LUUA developed the urinary leakage due to stent obstruction and required nephrostomy (IIIb, Clavien-Dindo classification). The remote results were traced for a period from 10 months to 6 years.The patients after LHNE (n=15) (22.1%) had a significant decrease of kidney function (>5%), including one patient (1.5%) with a complete loss of the function. An inflammatory process after partial ureteral resection was observed in the stump , which required relaparoscopy in 3 children (6.5%). The ipsilateral ureter injury during the total ureterectomy in the lateral position occurred in 2 children (6.9%). Conclusion. LHNE and LUPA (LUUA) are considered to be the effective surgical methods of duplex system megaureter in children. The disadvantage of LHNE is the high risk of significant decrease of kidney function; LUPA (LUUA) are the safer methods. Total ureterectomy in the supine position of a patient can prevent the complications associated with the healthy ureter injury and leaving the ureteral stump. What this paper adds For the first time, it has been proven that laparoscopic heminephrectomy in comparison with laparoscopic ipsilateral ureteropyeloanastomosis or ureteroureteroanastomosis is considered to be an unsafe operation, since this can cause kidney failure. It has been established that total ureterectomy in the supine position of a patient can prevent the complications associated with the healthy ureter injury and leaving the ureteral stump.

Minimally invasive treatment of iatrogenic ureter injury after gynecological surgery

Introduction. Iatrogenic trauma of the ureters accounts for 1-5.7% of all injuries to the organs of the genitourinary system, it is this that presents the greatest difficulty for diagnosis and the greatest danger in terms of the rate and frequency of development of severe, life-threatening complications (phlegmon of the retroperitoneal space, urinary peritonitis, sepsis. Description of the clinical case. Patient A., 47 years old. On June 17, 2019, laparoscopic uterine extirpation was performed for fibroids. 06/22/2019, iatrogenic injury of the lower third of the left ureter was diagnosed. Percutaneous puncture nephrostomy on the left was performed as the first stage for urine diversion. At the second stage, ureteroscopy on the left was performed, in which a burn zone was determined in the lower third of the left ureter, up to 0.5 cm in length with a defect of 1/3 of the ureteral circumference. Left kidney stenting was performed. After 2 months, the ureteral stent was replaced. At control computed tomography (4 months after surgery), the left ureter was contrasted along the entire length, no urodynamic disturbances were revealed. Discussion. Open surgical interventions for iatrogenic trauma of the ureter are long and traumatic, require a long rehabilitation period, accompanied by social maladjustment of patients, therefore the use of X-ray endoscopic methods of treatment is an effective and alternative method of treating this pathology. Conclusion. In this case, timely detection of iatrogenic damage to the ureter made it possible to perform an effective minimally invasive surgical treatment, which saved the patient from possible severe complications.

Laparoscopic-assisted Soave operation for the treatment of Hirschsprung disease in children: 5 years of experience

Purpose The purpose of this study was to summarize the clinical experience of the laparoscopic-assisted Soave operation for the treatment of Hirschsprung disease in children. Methods In total, 186 children with Hirschsprung disease participated in this study from January 2014 to January 2019. The Soave operation was used to treat Hirschsprung disease with laparoscopic assistance. Symptoms and signs were followed up at one week, one month, three months, six months, one year and every 1-2 years after the first year. Results All 186 children underwent laparoscopic surgery successfully, and none progressed to open surgery. During hospitalization and follow-up, there were 49 patients with complications, including 1 patient with an anastomotic leakage, 1 with an anal stricture, 5 with constipation recurrence, 5 with dirty defecation, 22 with enterocolitis, and 15 with perianal erosion. There were no complications such as abdominal bleeding, abdominal infection, ureter injury, adhesive intestinal obstruction, anastomotic stricture, incontinence. Conclusion The laparoscopic-assisted Soave operation is a safe and feasible method for the treatment of Hirschsprung disease in children. This method has the advantages of less trauma and good cosmetic effects.

Effectiveness of the self-retrieval basketing technique for stone extraction during flexible ureteroscopy for urolithiasis

Background To assess the safety and effectiveness of using the self-retrieval basketing technique by solo surgeon as a method for stone extraction during flexible ureteroscopy (f-URS) for urolithiasis. Methods This retrospective study enrolled patients with urinary calculus who underwent f-URS at two institutions in Japan between September 2014 and November 2019. A total of 100 cases were performed by one experienced surgeon using the self-retrieval basketing technique. With this approach, the f-URS apparatus was manipulated with the nondominant hand and the basket catheter was manipulated with the dominant hand. The self-retrieval basketing technique employed two parts—specifically, a “front catch” and “side catch” to gather fragmented stones visible in the front and side of the ureteroscopic view, respectively. We retrospectively examined perioperative results, complications, and the stone free rate (with “stone-free” defined as ≤ 2 mm with kidney ureter bladder (KUB) 1 month after f-URS) to estimate the safety and effectiveness for comparison with results of the conventional retrieval basketing technique. Results Among our study population, the median stone size was 14 mm and the median operative time was 80 minutes. A stone free status was achieved in 87 patients (87%). The median stone fragmentation time was 16 minutes and the stone retrieval time was 32 minutes. All included cases were completed with the self-retrieval basketing technique. Complications related to stone retrieval were identified in two cases (2%); the degree of ureter injury being Clavien grade IIIa. There were no intraoperative complications such as heavy hematuria not to detect ureteral mucosa. Conclusions The self-retrieval basketing technique is safe and effective for the extraction of stone fragments during f-URS for urolithiasis. The self-retrieval basketing technique does not require assistance for basketing; therefore, f-URS with active retrieval basketing could be completed by solo surgeon.

Laparoscopic-assisted Soave operation for the treatment of Hirschsprung disease in children: 5 years of experience

Purpose: The purpose of this study was to summarize the clinical experience of the laparoscopic-assisted Soave operation for the treatment of Hirschsprung disease in children. Methods: In total, 186 children with Hirschsprung disease participated in this study from January 2014 to January 2019. The Soave operation was used to treat Hirschsprung disease with laparoscopic assistance. Symptoms and signs were followed up at one week, one month, three months, six months, one year and every 1-2 years after the first year. Results: All 186 children underwent laparoscopic surgery successfully, and none progressed to open surgery. During hospitalization and follow-up, there were 49 patients with complications, including 1 patient with an anastomotic leakage, 1 with an anal stricture, 5 with constipation recurrence, 5 with dirty defecation, 22 with enterocolitis, and 15 with perianal erosion. There were no complications such as abdominal bleeding, abdominal infection, ureter injury, adhesive intestinal obstruction, anastomotic stricture, incontinence. Conclusion: The laparoscopic-assisted Soave operation is a safe and feasible method for the treatment of Hirschsprung disease in children. This method has the advantages of less trauma and good cosmetic effects.