ABSTRACT
【Objective】 To explore the feasibility and efficacy of laparoscopic bladder muscle flap ureteroplasty in the treatment of long-segment injury in the middle and lower ureter and to summarize the clinical experience. 【Methods】 The clinical data of 6 patients treated in our hospital during Oct.2018 and Aug.2021 were retrospectively analyzed. Four of them had long-segment ureteral mucosal cuff-like avulsion during ureteroscopic lithotripsy and could not undergo end-to-end ureteral anastomosis or reimplantation, and then laparoscopic bladder muscle flap ureteroplasty plus lumbaris major fixation of the bladder was performed immediately. The other 2 patients had to undergo this procedure due to stricture. 【Results】 All operations were successful. The median ureteral avulsion or ureteral stricture length was 14.5(6, 16) cm, muscle flap length 16.5(8,18) cm, operation time 190 (160, 240) min, blood loss 175 (100, 250) mL, postoperative hospital stay 8 (7, 12) days, and postoperative creatinine (89.38±21.74) μmoI/L. No major complications occurred. One patient developed urinary leakage, which returned to normal after active glycemic control and nutritional therapy; one patient developed postoperative absorption fever, which recovered after physical cooling. During the follow-up of 6 to 45 months, CT showed mild hydronephrosis in some patients, but no ureteral stenosis, impaired renal function or other complications, and patients complained no subjective discomfort. 【Conclusion】 Laparoscopic bladder muscle flap ureteroplasty is safe and effective for patients with long-segment injury in the middle and lower ureter. It has the advantages of small trauma, few long-term complications, and rapid recovery and improvement of renal function. If necessary, it can be combined with lumbaris major fixation of the bladder to shorten the distance from the muscle flap to the broken end of the ureter and to reduce the tension of the anastomosis.
ABSTRACT
Currently, the total ureteral avulsion are mainly secondary to ureteroscopy, and it is rarely caused by uterine evacuation clinically. This paper reported a case of total ureter avulsion after uterine evacuation, treating by ileal replacement for ureter under general anesthesia, and the surgical outcome was good. Uterine evacuation is a routine, less risky procedure, but it also can lead to serious complications such as total ureteral avulsion or bladder rupture. For potential high-risk patients with uterine evacuation, preventive measures such as accurate localization under B-ultrasound guidance or pre-operative ureteral stents indwelling are useful to avoid the occurrence of such serious complications. If total ureteral avulsion occurs, ileal replacement for ureter is a viable and effective treatment.
ABSTRACT
Urinary system complication is one of the common and serious complications in radical operation of cervical cancer. Timely detection and treatment is the key to improve the outcome. This article mainly introduces the latest progress in the early diagnosis, treatment and prevention of ureter injury, bladder injury and postoperative urinary retention during radical operation of cervical cancer, in order to improve our ability to detect and treat urinary system complications in time, reduce the occurrence of serious complications and minimize the harm to patients.
ABSTRACT
@#Distal ureteral injury is a rare complication of laparoscopic radical prostatectomy (LRP). The authorsreport such a case which was repaired successfully with an exclusively laparoscopic approach. Theyalso describe the advantages of the flank position when performing this minimally invasive approach.@*THE CASE@# 61-year-old Filipino male, with a PSA of 10 ng/cc, diagnosed with localized prostatecancer undergoes LRP, utilizing a posterior approach to the seminal vesicles. Intraoperatively, alarge intravesical median lobe was noted which was dissected meticulously after the division of thebladder neck. The excision of the 60gm prostate was completed in the conventional manner followedby a urethrovesical anastomosis. Blood loss was minimal with no apparent intraoperative events.Histopathology confirmed prostate cancer, Gleason score (4+3) with negative margins. Postoperatively,he had progressively high pelvic drain output and noticeably a relatively low urethral catheter output.CT urogram done on POD 8 showed a distal left ureteral disruption with intraabdominal extravasation.The authors performed a laparoscopic left ureteroneocystostomy on POD 9. The patient did wellafter the repair. After removing the indwelling catheter on postoperative day 14, he was dischargedin a good clinical condition. The ureteral stent was removed one month after the reimplantation.Follow-up CT urogram showed unobstructed flow through the reimplanted left ureter. Follow-upPSA at this time was 0.01ng/cc.@*CONCLUSION@#Ureteral injury following LRP is a devastating complication which may go undiagnosedintraoperatively. Prompt recognition, followed by a timely minimally invasive repair through alaparoscopic approach is needed to correct this problem.
ABSTRACT
Objective: To summarize the research progress of ureteral injury in oblique lumbar interbody fusion (OLIF). Methods: The literature about incidence, clinical manifestations, diagnosis, and treatment of ureteral injury complications in OLIF was reviewed. Results: OLIF surgery poses a risk of ureteral injury because its surgical approach is anatomically adjacent to the left ureter. Ureteral injuries in OLIF are often insidious and have no specific clinical manifestations. CT urography is a common diagnostic method. The treatment of ureteral injury depends on a variety of factors such as the time of diagnosis, the location and degree of injury, and the treatment methods range from endoscopic treatment to replacement reconstruction. Conclusion: Surgeons should pay attention not to damage the ureter and find the abnormality in time during OLIF. High vigilance of abnormalities is conducive to the early diagnosis of ureteral injury. Furthermore, it is important to be familiar with ureter anatomy and gentle operation to prevent ureteral injury.
ABSTRACT
An 84-year-old man electively underwent abdominal aortic open repair for an abdominal aortic aneurysm. During the operation, the ureter was not confirmed when manipulating the iliac arteries. Subsequently, intestinal paralysis occurred on the fifth day after surgery and a drainage tube of the intestinal tract was inserted. Liquid retention around the left iliopsoas muscle, and left renal nephropathy were recognized on performing enhanced computed tomography (CT) on postoperative day 11. An initial diagnosis of an iliopsoas abscess was considered. Simple CT imaging was performed on the 13th day after surgery without symptomatic improvement. This scan revealed that the contrast agent had remained in the cavity since the previous CT scan, which had been misdiagnosed as an abscess. Ureteral injury was now suspected. Retrograde ureterography revealed an urinoma caused by left ureter injury. We diagnosed paralytic ileus due to urinoma. For drainage of the urine, a percutaneous renal fistula was constructed. He was discharged from the hospital on the 56th postoperative day, and by six months after the operation, the urinary tract problem had disappeared. In conclusion, we report a case of delayed ureteral injury that occurred after abdominal aortic open repair surgery.
ABSTRACT
Objective To explore the value of ureteroscopy in the diagnosis and treatment of ureteral injury caused by laparoscopic hysterectomy . Methods Suspect ureteral injury occurred in 23 cases out of 578 laparoscopic hysterectomy from January 2010 to December 2015 in our hospital.Among them, 12 cases were testified by ureteroscopy .A double-J catheter was placed in for 3 months. Results All the 12 cases were followed up for 3-26 months (average, 19 months).The double-J catheter was removed at 3 months after surgery .The continuity of the affected side urinary tract was restored in 10 cases and hydronephrosis was not found by B ultrasound .Two cases were found ureteral obstruction and were given ureterovesical reimplantation at 3 months after surgery . Conclusions The ureteroscopy should be carried out as early as possible for patients with suspect ureteral injury after laparoscopic hysterectomy .Double-J catheter placement can avoid parts of patients converting to open surgery .
ABSTRACT
Objective:To evaluate the safety and efficacy of retroperitoneal laparoscopic nephrectomy with autotransplantation in cases of severe iatrogenic proximal ureteral damage.Methods:From July 2011 to March 2015,two patients,aged 44 (female)and 54 years (male),underwent retroperitoneal laparoscopic nephrectomy and autotransplantation for treatment of severe iatrogenic proximal ureteral inju-ries.Both injuries were proximal ureteral avulsion during ureterolithotomy with the holmium laser for ure-teral calculi.computed tomography angiography (CTA)and computed tomography urography (CTU)was performed in both patients before operation.A 3-port retroperitoneal technique was used for the patients placed in a lateral decubitus position.A retroperitoneal laparoscopic nephrectomy with autotransplantation approach was used in both the patients,and the kidneys were removed to the right iliac fossa.Case 1’s kidney was removed through the right Gibson incision,while Case 2’s kidney was removed through the left lumbar incision.The renal artery and renal vein were ligated using the Hem-o-lok.The kidneys were taken out quickly from the patients and infused with 4 ℃ kidney preserving fluid immediately.Results:The retroperitoneal laparoscopic nephrectomy with autotransplantations was performed 4 hours in Case 1 and 2 years in Case 2 after atrogenic proximal ureteral injuries.Case 2 was associated with dense peri-nephric and perihilar fibrosis.The procedures were successful,with immediate return of renal function in both the patients.After ex vivo graft preparation,ureteral and vessel length and quality were adequate for transplantation in both the cases.A direct ureterovesical anastomosis was performed in both patients.In the 2 patients,the warm ischemia time was 3 and 5 minutes,the total operation time 185 and 246 mi-nutes,and the estimated blood loss 70 and 200 mL,respectively.No perioperative complications oc-curred.At the end of the follow-up,the transplanted kidneys were functional,and the patients had re-turned to their normal activity.Conclusion:Retroperitoneal laparoscopic nephrectomy with autotrans-plantation is an excellent alternative to nephrectomyor bowel interposition in patients with proximal urete-ral loss.This procedure is associated with acceptable morbidity and preserves the renal function.This re-port supports the safety and efficacy of retroperotoneal laparoscopic nephrectomy with autotransplantation in experienced hands.
ABSTRACT
Introduction: Ureteral trauma can result from various noxas the most frequent iatrogenic. Additional this, external causes: blunt trauma, sharp weapon and gunshot contributing to the overall incidence. Its early diagnosis although great importance to avoid complications is difficult so it is their suspect is essential when confronted with trauma patients. Case reports: We report five patients aged 15 to 46 years with ureteral trauma. Two patients had gross hematuria, one patient acute abdominal pain and two as hypovolemic shock. The lesions were found mainly to the left ureter and in smaller proportion in right ureter. Four patients the diagnosis was surgical exploration and one case was performed by scans. All were operated, had an uneventful postoperative period and are currently asymptomatic.
Introducción: El trauma de uréter puede ser resultado de diferentes noxas siendo la más frecuente la iatrogénica. Adicional a esto, las causas externas de trauma contuso, las causadas con arma cortopunzante y las realizadas por arma de fuego contribuyen a la incidencia global. Su diagnóstico temprano, aunque de gran importancia para evitar complicaciones, resulta difícil por lo que es primordial su sospecha cuando nos enfrentamos a pacientes politraumatizados. Casos clínicos: Se identificaron 5 casos de trauma ureteral en nuestro hospital desde septiembre de 2012 a agosto de 2013. La mediana de edad fue 24,5 años (15-46 años). Se manifestaron como hematuria macroscópica en dos casos, un caso como dolor abdominal agudo y dos como choque hipovolémico. Estas lesiones se encontraron principalmente localizadas hacia uréter izquierdo y en menor proporción en uréter derecho, todas de tipo penetrante, causadas por arma de fuego. En 4 pacientes el diagnóstico fue por exploración quirúrgica y un caso fue realizado a través de escanografía. Los pacientes fueron intervenidos quirúrgicamente, ninguno presentó complicaciones y se encuentran actualmente asintomáticos.
Subject(s)
Humans , Adolescent , Adult , Young Adult , Middle Aged , Wounds and Injuries/surgery , Wounds and Injuries/diagnosis , Ureter/surgery , Ureter/injuriesABSTRACT
Objective To investigate the clinical value and adverse reactions of indwelling ureteral stentsinthepreventionofureteralinjurybeforecomplexpelvictumorsurgery.Methods 145casesofpatients with rectal cancer ,cervical cancer ,ovarian cancer and pelvic sarcomas were retrospectively analyzed ,and 53 pa-tients with complex pelvic tumor surgery ,preoperative were under cystoscope unilateral or bilateral ureteral stent tube,pulled out according to the intraoperative situation after surgery or lien ,92 patients as control group .Results Ureteral injury was found in 10 of the 145 patients,2 cases in ureteral catheter group and 8 cases in control group .3 cases of postoperative ureteral fistula occurred in the control group .Indwelling ureteral stents could cause adverse reactions such as hematuria ,osphyalgia and urinary irritation ,and the adverse reactions of catheter group was obviously higher than that of control group (P<0.05).Conclusion Cystoscopic ureteral stent placement has important clinical significance for prevention of ureteral injury despite certain adverse reactions ,which can be used in operation of complex pelvic tumor .
ABSTRACT
Objective To investigate the application of ureteral catheter in complicated gynecological laparoscopic surgery for the prevention of ureteral injury . Methods A total of 182 cases of gynecological laparoscopic surgery performed from January 2009 to November 2011 were selected as study group .Bilateral ureteral catheters were inserted under cystoscopy , and then laparoscopic surgery was performed under the instruction of the catheter .The catheter was immediately removed after the surgery .A total of 200 cases of laparoscopic surgery were selected as control group and preoperative ureteral catheterization was not applied in this group .The incidence rate of ureteral injury was compared between the two groups . Results The success rate of bilateral ureteral catheterization in the study group was 98.9%(180/182)and no ureteral injury occurred .In the control group, ureteral injury was found in 2 cases, which were converted to open surgery for ureter repair and double J stent was retained .The 2 cases recovered 2 months after the surgery.Bladder injury was found in 2 cases during the surgery , which received immediate repair assisted by surgeons from the department of urinary surgery and recovered 2 months after postoperative catheterization . No statistical difference was found in complication rate between the two groups ( P=0.125 ) . Conclusion The application of ureteral catheterization in complicated gynecological laparoscopic surgery can reduce the risk of intraoperative ureteral injury .
ABSTRACT
Objective To summarize the experience of diagnosis and treatment of iatrogenic injury by ureteroscopic surgery.Methods Retrospective analysis of 13 cases with iatrogenic injury by ureteroscopy from December 2008 to December 2011,including 8 men and 3 women,aged 15 to 75 years.Among the 13 cases (Holmium laser lithotripsy under ureteroscope),there were 5 cases of ureterostoma severe disruption,4 cases of submucosa injury,2 cases of perforation,1 case of disruption,and 1 case of sleeve exfoliation of mucosa.Results Among these 13 cases with iatrogenic injury by ureteroscopy,10 cases underwent double J drainage (drainage duration:60 days),and 3 cases underwent open surgery immediately.There was no hydronephrosis when examined by IVU after six months to two years follow-up.Conclusions The skills and techniques of surgical operation should be improved when performing ureteroscopic operation,and it is essential to be familiar with ureteric dissection and alignment,which can avoid ureteric injury.Indwelling D-J tube is very important in dealing with mild ureteral injury secondary to ureteroscopes.Surgical intervention should be given to severe cases of ureteric injury in time.
ABSTRACT
Objective To investigate the etiology and treatment of iatrogenic ureteral injury(IUI) and bladder injury(IBI). Methods Forty-seven patients(7 males, 40 females) with ureteral and bladder inju-ries caused as a result of any medical procedures were reviewed from 1996 to 2007. Obstetrics and gynecolog-ical, urological,general surgical procedures were involved in 38, 6, and 4 of the injuries respectively. Re-sults Sixteen cases of IUI were found during operation, including 14 cases of entire ureteral laceration, 4 cases of partial ureteral laceration. Thirteen cases received ureteral anastomosis, one case received uretero-neopyelostomy. One case of ureteral perforations during ureteroscopic procedure was indweUed of double-J after the operation was terminated immediately. Three cases received nephrectomy. Four cases of lower ure-teric suture ligation and three cases of ureterovaginal fistula were detected at 3 days～ one week of postopera-tion. These 7 cases were received ureteroneocystomy during 2 weeks after the initial surgical procedure. Nineteen cases of IBI were found during operation, the length of cystic wound was ranging from 1 cm to 3 cm. 17 cases underwent repairing, 2 eases of bladder perforation which caused by endourologic or TVT procedure received catheterization for 1 week. Five cases of vesicovaginal fistula which were found during one week--one month of post-operation, were received fistula resection and bladder repairing 3 months after of initial operation. Forty-seven cases were follow-up ranging from 5 months to 11 years after the second opera-tion,mean time were 47 months. All cases were recovered. Conclusions Intraoperative findings and effec-tive treatments can achieve good therapeutic effects and avoid injury during secondary operation. Correct treatment of urinary fistula can promote cure rate.
ABSTRACT
Objective To evaluate the repairing effect of pedicle omentum on severe ureteral in-jury. Methods Twenty healthy dogs were randomized into the experiment group and the control group. Firstly the model of severe ureteral injury was made. In experimental group, the pedicle omen-turn were used to wrap up the severe injured ureter, but which was no done in control group. Urinary fistula and ureteral necrosis were observed. At 12 weeks postoperatively,the models were re-operated to investigate whether the severe injured ureters had healed. Angiogenesis, VEGF and its receptor KDR were also examined in stoma and surrounding tissue histopathologically. Results No urinary fistula was observed in experimental group, but 2 cases in control group were dead because of recurrent abdominal cavity infection after the formation of urinary fistula. The mucosa and smooth muscle of stoma were completely regenerated, and the blood vessels were regenerated more significantly in expe-rimental group than in the control group. In experimental group, the VEGF and KDR were over-ex-pressed, and the positive cell rates were (12. 65±0. 02)% and (10. 23±0. 03)%. But in control group, the stoma were not healed, and severe ureters1 strictures were observed in all dogs. Angiogene-sis was not signifieant, the VEGF and KDR positive cell rates were (1.54±0. 03)% and (2. 654± 0.04)%, respectively. Conelusions Pedicled omentum can promote the repair of severe ureteral in-jury. The mechanism may be the over expression of VEGF and KDR in prompting angiogenesis.
ABSTRACT
Iatrogenic ureteral injury is a complication that can occur during a variety of pelvic or abdominal surgeries. The most frequent causes are gynecological ones, followed by colon and vascular surgeries. Management of ureteric injury depends on the time of diagnosis and the severity of organ damage. Injuries diagnosed intraoperatively should be treated immediately. Occasionally, intraoperative ureteral injury is overlooked, and symptoms of the late diagnosis of ureteral injury are usually nonspecific; therefore, the diagnosis is delayed for days or weeks postoperatively. Management of injuries diagnosed postoperatively is more complex. There are differing opinions on whether an initial conservative or immediate operative intervention is the best line of action. Delayed repair is suggested on the grounds that it will reduce inflammation and tissue edema. However, many authors are in favor of early repair, perhaps because tissue planes are easier to find before fibrosis becomes too dense. Ureteral injuries occurring at the level of the pelvic brim should be best managed with an end-to-end anastomosis, preferably around a ureteric stent. More distal injuries also should be ideally managed with an end-to-end anastomosis, after excision of the crushed or compromised segments. However, if the remaining distal segment is short, ureteral reimplantation is the procedure of choice. The Boari flap technique for ureteral reimplantation is invaluable in cases with a short proximal segment. Delayed recognition of iatrogenic ureteral injury may be associated with serious complications, so prompt recognition of ureteral injuries is important. Recognition of the injury before closure is the key to easy, successful, and complications-free repair. Increased awareness of the risk for ureteral damage during certain operative maneuvers is vital to prevent injury, and to decrease the incidence of iatrogenic injury. A sound knowledge of abdominal and pelvic anatomy is the best prevention.
Subject(s)
Colon , Delayed Diagnosis , Edema , Fibrosis , Iatrogenic Disease , Incidence , Inflammation , Replantation , Stents , UreterABSTRACT
OBJECTIVE: To estimate the effect of diagnostic cystoscopy in early detection of ureteral injury at the time of total laparoscopic hysterectomy. METHODS: Retrospectively 598 women who received total laparoscopic hysterectomy from August 2004 to August 2006 were included. They were divided into two groups : no cystoscopic examination (n=398) group (Group A) and routine intraoperative diagnostic cystoscopic examination after intravenous indigo-carmine injection (n=200) group (Group B). The rates of ureteral injury after total laparoscopic hysterectomy were compared between both groups. RESULTS: Postoperative ureteral injury was observed in 3 case of Group A (3/398 : 0.75%) and in no case of Group B. In 2 cases of group B (2/200 : 1.00%), Intraoperative ureteral injury was detected by cystoscopy. CONCLUSION: Routine intraoperative diagnostic cystoscopy allows for early recognition and treatment of obstructive ureteral injuries, and reduces the rate of late postoperative ureteral complications during advanced laparoscopic procedures.
Subject(s)
Female , Humans , Cystoscopy , Hysterectomy , Retrospective Studies , UreterABSTRACT
Objective To investigate the ureteral injury in gynecological laparoscopies and discuss its diagnosis,treatment and prevention.Methods Six cases of ureteral injury were reviewed.The clinical features including the type of diseases,uterine size,pelvic adhesion and the methods of diagnosis,treatment were studied.Results Ureteral injuries happened during laparoscopically assisted vaginal hysterectomy(LAVH). The gynecological disorders included pelvic adhesions,endometriosis and leiomyoma in cervical.Patients presented flank pain,fever,increased volumes discharge.Conclusion Ureteral injury is an uncommon and sever complication in gynecological laparoscopies.Fever,flank pain and abnormal vaginal discharge should be paid attention to be ureteral injury.
ABSTRACT
Objective To search for the technique of increased safety and diminished blood loss through laparoscopic hysterectomy. Methods A technique for dissecting the pelvic retroperitoneum and identifying the ureters and uterine arteries was used in the right pelvic side wall. The left side was used a non-anatomical approach. Visualization of the right ureter necessitate opening the peritoneum of the right pelvic side wall. A technique of identification and dissection the right ureter and the uterine vessels retroperitoneal at the initiation of laparoscopic hysterectomy was used. First, the obliterated hypogastric arteries were identified retroperitoneally. Second,the paravesical and the pararectal spaces are developed. Finally, the ureter and the uterine vessels were easily identified from the pararectal space. Once the retroperitoneal dissection had been completed and vital structures identified, hysterectomy be carried out. Results WT Fifty patients underwent this procedure. Right pelvic side wall versus left mean operation time was 33 min versus 22 min, and the mean blood loss was 12 versus 30 ml. It took 21 min on average to identify the right ureter and the uterine vessels retroperitoneal. Conclusion Identification and dissection of the ureter and the uterine vessels retroperitoneal is an acquired skill. This technique increases safety and diminishes blood loss. The uterine arteries and the uterosacral ligament are confidently desiccated once the path of the ureter near is identified. A non-anatomical approach to laparoscopic hysterectomy may be easier to learn, but it is neither very versatile nor safe.
ABSTRACT
Radical hysterectomy with pelvic lymph node dissection (RHPLD) was considered as primary management of cervical cancer (stage I and IIa). RHPLD provides for resection of paracervical and paravaginal tissues at the lateral pelvic walls, transaction of the uterosacral ligament, ligation of uterine vessels and excision of pelvic lymph node from the surrounding vessels. The urinary tract disturbance was the most frequent and significant postoperative complication. Among 82 patients who had undergone radical hysterectomy with pelvic lymph node dissection for cervical cancer from July 1983 to December 1989, 43 patients who were treated for urologic complications, were reviewed retrospectively. The age distribution was even from 4th to 6th decades. The common urologic complications were neurogenic bladder dysfunction 28 (34.2%). Ureteral injury 15 (18.3% ), UTI 12 (14.6% ), stress incontinence 5 (6.1%). Each urologic complication and its management are discussed.
Subject(s)
Humans , Age Distribution , Hysterectomy , Ligaments , Ligation , Lymph Node Excision , Lymph Nodes , Postoperative Complications , Retrospective Studies , Ureter , Urinary Bladder, Neurogenic , Urinary Tract , Uterine Cervical NeoplasmsABSTRACT
We treated 11 patients with iatrogenic ureteral injuries during a 4-year period: Gynecologic operations were the most common antecedent surgical procedures (82 percent). The diagnosis of ureteral injuries was made immediately in 4 patients and was delayed 3 to 56 days in 7. Three of the 4 injuries recognized during an operation were repaired successfully at the time of injury ; the primary repair in the remaining patient leaked and ultimately resulted in a nephrectomy because of subhepatic and retroperitoneal abscess formation. In the delayed diagnosis group, retrograde ureteral catheterization was successful in only 1 of all attempts. Of the 7 patients with injuries recognized in the postoperative period. 4 were managed successfully with ureteral stenting or percutaneous nephrostomy alone 3 required surgical after temporary percutaneous nephrostomy drainage.