BACKGROUND Ureteric and bladder injury is a serious concern during pelvic surgery and represents one of the most dreaded complications during gynaecologic operations with an overall incidence ranging from 0.5% to almost 30%. The rate of ureteral injury is increased when technically demanding laparoscopic and radical pelvic surgeries. Aims and Objectives-To study the incidence of ureter and bladder injuries detected intraoperatively/ postoperatively following pelvic surgeries in the gynaecology and oncology departments of our institution. This study describes our experience in the management of ureteric/ bladder injuries following pelvic operations and outcome of management of this condition in our local setting. MATERIALS AND METHODS This is a retrospective descriptive study of patients with iatrogenic injuries to the ureter and bladder following pelvic surgeries that were managed in our department from June 2016 to January 2018. Analysis of the patient's diagnosis, indication for surgery, type of surgery, time at diagnosis of injury, presenting features and the type of management was done. RESULTS A total of 9 ureteric injuries and 6 bladder injuries were identified out of 293 pelvic surgeries performed in the study period. All bladder injuries were diagnosed and managed intraoperatively. 80% of ureteric injuries were diagnosed postoperatively with fever, flank pain and leakage of urine being the most common presentation. Duration of symptoms ranged from immediate post-op period to up to 6 months after surgery. 45% were diagnosed with ureteric stricture, 33% with ureterovaginal fistula and 22% were diagnosed intraoperatively. Incidence of ureteric injuries in simple hysterectomy for benign causes was 1.8% and for Wertheim's hysterectomy for malignancy was 6%. Incidence of ureteric injuries following laparoscopic hysterectomy was 7%. Ureteric injury following APR was found to be 7%. We performed ureteroneocystostomy for 4 cases, Boari flap for 2 cases, transureteroureterostomy in 1 case, nephrectomy in 1 case and ureterocolonic anastomosis in 1 patient. Postoperative complications observed were surgical site infection in 33% and urosepsis in 11% of patients. Mortality was nil. CONCLUSION Laparoscopic and Wertheim's hysterectomy were most commonly associated with ureteric injuries. Meticulous surgical technique as well as identification of the course of the ureter and associated anatomic locations where injury is most likely to occur is important to decrease the risk of ureteric injury. Timely recognition of ureteric injury and its management is associated with good outcome.
Background: Arteriovenous fistulae (AVF) are the dialysis access modality of choice for patients with end stage renal disease (ESRD). Many children have poor vein caliber which renders them unsuitable for performing AV fistula and those end up in chronic tunneled hemodialysis catheter. The longer maturation time in children than that in adults and the technical difficulties imposed by small diameters of the vessels are other challenges in operation on pediatric patients. Methods: Data collected from pediatric patients with endstage renal failure in whom HD access procedure was performed retrospectively and followed up and the following data were analyzed. study performed in Govt Omandurar Multi Super Speciality Hospital,Chennai. Affiliated to, The Tamilnadu Dr.M.G.R Medical University. Etiology of renal failure, time on dialysis, CKD history, and transplantation and type of HD access procedure, patency and functioning at 6 months for both were recorded. Patients of age 0 to 15 were included in this study, age was the only inclusion criteria. Results: children with growth less than 50th percentile tend to have poor vein caliber with ending in chronic HD catheter. Pre operative and prior vene puncture was present in (80%) patients in whom further AV fistula was not feasible. Patients with renal failure secondary to obstructive uropathy were favoring creation of AV fistula. Patients with no prior history of ICU admission for volume over load had better feasibility of AVF creation. Average time of HD( Hemo Dialysis) catheter patency in 6 months was 92%. Primary patency of AV fistula was 85% in 6 months. Maturation rates and secondary failure was not evaluated in this study. Conclusion: anatomic factors like vein diameter, prior venepuncture highly influence the type of HD access procedure. at 6 months chronic tunneled catheter had better patency than AV fistula. Proper education of the medical fraternity dealing with pediatric renal failure patients regarding these factor will help in long term functioning of the fistulas and patency of the HD catheter and survival. Adv. Res. 7(2), 565-568 568 the procedure and during hemodialysis helps in maintainingb the patencyof the hemodialysis catheter. proper education of the medical fraternity dealing with pediatric renal failure patients regarding these factor will help in long term functioning of the fistulas and HD catheter patency.. Int. J.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.