ABSTRACT
To study the feasibility and safety of localization of radiolucent urinary stones during ESWL utilising the refluxing intravesically injected contrast medium along indwelling ureteral stents. 2. To identify the optimum volume of contrast medium and the intravesical pressure at which adequate vesicoureteral reflux sufficient for collecting system opacification occurs. 3. To identify criteria by which successful localization can be predicted. With antibacterial prophylaxis, hundred mls. of contrast medium diluted with 500 ml normal saline was infused into the bladder through a Y shaped connection attached to a pre-inserted urethral catheter with the other limb connected to a water manometer for the purpose of continuous intravesical pressure recordings. The amount of infused contrast medium and intravesical pressure at which adequate visualization by fluoroscopy occurred was recorded. Successful stone localization was correlated with the infused contrast medium volume, intravesical pressure, infection, stone location, age, weight, stent duration and fluoroscopy time. Forty six patients were studied. Clear stone localization to facilitate shock targeting was achieved in 37 patients [80%]. This occurred with a mean contrast volume of 300 ml at 20 cm water mean intravesical pressure. Apart from urinary tract infection which was associated with a significantly lower success rate, there were no other criteria by which success can be predicted. There were no significant complications and all visualized stones disintegrated well and were completely cleared at 3 months. The method is safe, easy, repeatable and suitable for targeting radiolucent urinary stones during ESWL in patients with ureteral stents
ABSTRACT
To review the frequency of iatrogenic bladder injuries [IBI] occurring during obstetric and gynecological [OBG] procedures and we report a single center experience with these emergency urological consultations and interventions and analyze their outcomes and correlate them with the present day trends. We reviewed retrospectively the relevant data of all IBI during various OBG procedures from the Medical Records of Abha Maternity Hospital, the OBG wing of Assir Central Hospital, Abha, Saudi Arabia over a period of 4.5 years [September 2000 to February 2005]. Various relevant factors of the injuries were studied with their final outcome. Out of the 8,684 OBG procedures carried out during this period there were 20 occasions of IBI directly related, with an overall incidence of 0.23%. The majority of injuries were seen during obstetric procedures [85%] and 15% during gynecological procedures. Notably 90% of them were recognized intraoperatively and managed. Concomitant ureteric injury was noticed in 20% of the cases. Endourological and surgical options were both used in the management. Overall outcomes were very satisfactory, unrelated to the site, type or other associated injuries. The bladder is the most commonly injured organ during OBG interventions. Prompt recognition and repair of injuries should be the main goal. Gynecologists should be able to do at least a minimum diagnostic cystoscopy in emergency situations. It is well established that this can lessen, missing iatrogenic urinary tract injuries in this era of increasing gamut of gynecologic surgical and laparoscopic procedures