Diagnostics, treatment and prophylactics of the urine-issue ways trauma in endometriosis laparosurgery

United literature data and original authorsobservations concerning the problem of the urine-issue ways trauma in laparoscopic surgery in gynecology are presented in this article. Matters of intra- and after-operational diagnostics of such affections are considered. Concrete recommendations concerning prophylactics are given and own experience in treatment of urethra and urinary bladder injuries while laparoscopic curing in endometriosis patients is indicated.

Intraperitoneal Bladder Injury – A Conservative Approach

Iatrogenic bladder injuries with Intra-peritoneal extravasations are standardly managed surgically. However, we are presenting a case of iatrogenic intra-peritoneal bladder injury which developed after an emergency caesarean section that was managed successfully by conservative therapy. The trial of conservative approach may prove beneficial to minimize the chances of any invasive interventions in such cases. Bladder injuries are of two types namely intra-peritoneal and extra-peritoneal. Of which, extra-peritoneal is most common type.1 Bladder laceration happens during separation of bladder from uterine cervix during caesarean sections and abdominal hysterectomies.2 Usually bladder injuries are identified intra-operatively and managed on table. If diagnosis is made post-operatively, then management becomes challenging due to non-specific clinical features, exposure to radiation, sepsis due to urinary extravasation and prolonged hospital stay, psychological stress to both patient and surgeon. The clinical features suspicious of bladder injury are abdomen distension, urinary ascites, blood-stained urine, abdominal pain, paralytic ileus, fever and deranged renal parameters.3 Extra-peritoneal and intra-peritoneal bladder ruptures are treated differently. According to American Urological Association (AUA) guidelines, Intraperitoneal bladder injury needs surgical repair. There are limited case reports in literature about conservative management of small intra-peritoneal bladder lacerations. This is a case report of one such intra-peritoneal bladder injury treated with non-operative approach.

Urinary Incontinence after Planned Cesarean Hysterectomy for Placenta Accreta

<b><i>Introduction:</i></b> Data regarding the risk of incontinence after cesarean hysterectomy are lacking. We aimed to assess the risk of urinary incontinence in women who underwent planned cesarean hysterectomy for placenta accreta. <b><i>Methods:</i></b> This was a retrospective study of women who underwent planned cesarean hysterectomy for placenta accreta. The primary outcome was the incidence of post-cesarean hysterectomy urinary incontinence, defined as involuntary loss of urine between 3 and 12 months after cesarean hysterectomy. Outcomes were compared in a cohort of women who underwent planned cesarean hysterectomy for placenta accreta with a control group of women who underwent scheduled cesarean section without hysterectomy. <b><i>Results:</i></b> Forty-seven singleton gestations who underwent planned cesarean hysterectomy for placenta accrete were included in the study and were compared with 100 controls. Eight cases of bladder injuries were reported, 7 in the planned cesarean hysterectomy group and one in the planned cesarean delivery group. Overall, urinary incontinence was reported in 10 women of the planned cesarean hysterectomy group and in 8 women of the planned cesarean section group (21.3% vs. 8.0%; <i>p</i> = 0.03). <b><i>Conclusion:</i></b> Planned cesarean hysterectomy for placenta accreta is a risk factor for urinary incontinence.

Bladder Injury: A complication of Transobturator Tape Surgery

Minimally invasive vaginal surgeries are often a preferred mode of surgical treatment of stress urinary incontinence. It is associated with fewer complications. However, complications including hemorrhage, voiding dysfunction, infection, pain, skin infection and erosion, and bladder injuries are observed. We encountered intraoperative bladder injury in a 40-year-old female patient with stress urinary incontinence who underwent transobturator tape (TOT) surgery. Cystoscopy demonstrated a small defect post procedure. She was managed conservatively with foley catheterization for 2 weeks following TOT procedure. She was dry and continent upon follow up.

Extraperitoneal Bladder Injuries Associated With Pelvic Fracture Requiring Internal Fixation: What Is the Evidence?

Traumatic bladder injuries are commonly associated with pelvic fractures. While the majority of intraperitoneal bladder injuries are surgically repaired, extraperitoneal bladder injuries (EBIs) can be managed nonoperatively in the absence of complex injury patterns such as bladder neck injury or presence of bone spicules in the bladder. Concern for pelvic hardware contamination is one of the most common reasons for repairing EBIs at the time of orthopedic interventions for pelvic fracture (usually open reduction and internal fixation). However, given the inconsistent and limited evidence, practice patterns are different and largely depend on surgeon preferences and institutional management. In this review, we explore the roots for this concern and summarize the current evidence on risk of pelvic hardware infection with nonoperative management of EBIs.

A retrospective study of urological injuries during obstetrics and gynecological procedures

Background: Urological injury in obstetrics and gynaecology are not uncommon because there is a close anatomical association between reproductive and urological system. The objective of this study was to find out the incidence and types of urological injuries in obstetric and gynaecological procedures, clinical presentation and various management option in a tertiary care hospital.Methods: The study was a retrospective analysis of all obstetric and gynecological surgeries over a period of 6 years from January 2014 to December 2019. Cases with the documented urological injuries during these procedures were analyzed further.Results: Total 8595 patients had undergone different obstetrics and gynecology procedures, out of which 5429 were obstetrics and 3166 were gynecology surgeries. Out of 3166 of gynecology procedures, there were 16 cases (0.5%) of bladder injuries and one case (0.03%) of ureteric injury. Out of 5429 cases of obstetric procedures there were 11 (0.2%) cases of bladder injury and one case (0.01%) of ureteric injury.Conclusions: The incidence urological injuries during obstetrics and gynecological procedures are rare but the morbidity associated these are significant. Therefor surgeons should be more cautious and high degree of suspicion can help in early diagnosis and avoid the sequel.

High Riding Prostate: Epidemiology of Genitourinary Injury in Motorcyclists from a UK Register of over 12,000 Victims

Background: The mechanism of motorcycle accidents (high speeds, pelvis behind fuel tank) may predispose to genitourinary injury (GUI) but the epidemiology is poorly understood. Previous studies have assessed GUI patterns in cyclists, and road traffic accident victims in general, but no study has analyzed GUI patterns in a large cohort of motorcyclists. Objectives: We aimed to better understand patterns of urological injuries among motorcyclists admitted to hospital. We aimed to determine any relationship between pelvic fracture and GUI patterns or severity. Methods: The Trauma Audit Research Network was reviewed to identify motorcyclists admitted between January 2012 and December 2016 (n = 12,374). Cases were divided into riders (n = 11,926) and pillion passengers (n = 448), and the data analyzed to identify urological injuries and their associations. The associations between pelvic fracture and other injury types were tested for significance by one- and two-way χ2. Results: GUI was identified in 6%. Renal trauma was the most common GUI among riders (4%) and pillions (2%). There was no statistically significant relationship between grade of renal trauma and presence of pelvic fracture. Urethral injury occurred in 0.2% of riders and passengers, and bladder injury in 0.4% of riders and 0.7% of pillions. Urethral and bladder injuries were positively associated with pelvic fracture, which was present in 81 and 92%, respectively. Testicular trauma occurred in 0.4% of riders and 0.7% of pillions. Body armor was recorded in 3% of casualties with urological trauma, and 3% overall. Conclusions: A significant proportion of motorcyclists brought to accident and emergency department have GUI, most commonly renal trauma. Pelvic fracture is more common in pillion passengers than riders, and associated with urethral and bladder injuries, but it does not predict severity of renal trauma. External genital injuries are rare, but we recommend examination in the tertiary survey, as consequences of missed injury are severe. Further research is needed to explore protective effects of motorcyclist clothing.