BackgroundPreoperative uterine artery embolization has been shown to help reduce blood loss, with few complications. Most reports indicated that uterine artery embolization is safe for uterine fibrosis; the occurrence of hyperkalemia and acute kidney failure as complications of preoperative uterine artery embolization has not been reported previously. Here we report the occurrence of hyperkalemia and acute kidney failure after preoperative uterine artery embolization for a large uterine fibroid. To the best of our knowledge, this is the first report on the occurrence of hyperkalemia and acute kidney failure after preoperative uterine artery embolization.Case presentationA 48-year-old Japanese woman presented to our hospital complaining of compression in her abdomen and an abdominal mass. Magnetic resonance imaging showed a large uterine fibroid measuring 37.5×27×13.5 cm. Therefore, we planned preoperative uterine artery embolization to help reduce blood loss. However, hyperkalemia and acute kidney failure occurred owing to the development of necrotic tissue after uterine artery embolization; therefore, emergency total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. She experienced 105 g of blood loss intraoperatively. The weight of her uterus was 10.8 kg and the volume was 9964 cm3, with extensive necrotic tissue. Her hyperkalemia and kidney failure resolved after the surgery.ConclusionsWe reported the occurrence of serious complications, including hyperkalemia and acute kidney failure, after preoperative uterine artery embolization for a large uterine fibroid.
While laparoscopic sacrocolpopexy is a well-established laparoscopic procedure in the management of pelvic organ prolapse in Western countries, laparoscopic sacrocolpopexy is not widely accepted in Japan. We report four cases in which laparoscopic sacrocolpopexy was performed to treat severe pelvic organ prolapse. The patients were in the 7th and 8th decades of life. Two patients were pelvic organ prolapse quantification(POP-Q)stage Ⅲ and two patients were POP-Q stage Ⅳ. Two of the four patients(# 1 and 2)had pollakisuria and stress urinary incontinence preoperatively. While intraoperative bleeding was not excessive, the operative time tended to be prolonged, ranging from 210-313 minutes {275.25 ± 45.68(mean ± SD)minutes}. A complication occurred in one patient (# 3). Specifically, strangulation ileus resulting from trocar site herniation occurred on post-operative day 2, for which emergent surgery was required. The anatomic recurrence rate was 25% (1 of 4). Patient # 3 had recurrent prolapse 7 months after the laparoscopic surgery and re-operation was performed. The pre-operative urinary symptoms in patient # 1 were improving. Patient # 2 was improving, but not completely. Laparoscopic sacrocolpopexy may be useful in the management of pelvic organ prolapse; however, improvement in the surgical technique is needed to decrease invasiveness and reduce the complication and recurrence rates.
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