Accuracy of cystoscopy in the diagnosis of ureteral injury in benign gynecologic surgery

Dandolu, Vani; Mathai, Elcy; Chatwani, Ashwin; Harmanli, Oz; Pontari, Michael; Hernández, Enrique

doi:10.1007/s00192-003-1095-7

Cited by 67 publications

(27 citation statements)

References 18 publications

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“…Abnormal IVP findings were associated with a uterine size greater than 12 weeks and an adnexal mass of 4 cm or more. Dandolu et al [19] identified a large uterus as a risk factor for ureteric injury. The clinical application of these observations is limited.…”

Section: Discussionmentioning

confidence: 99%

A radiological study on the anatomical proximity of the ureters and the cervix

et al. 2007

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In order to evaluate risk factors for anatomical proximity between the cervix and the ureters the distance between the ureters and the cervix was measured in 499 computerized tomography (CT) studies at the most dorsal reflection of the ureters. The relationship between the ureter-cervical distance and the presence of pelvic pathology was assessed by correlation tests and regression analysis. Of the 499 CT studies, 252 demonstrated radiographic pathologies. Among abnormal scans, 126 (50%) involved cervical pathology. At least one ureter was within 0.5 cm of the cervix in 3.6% of patients with normal CT scans and in 10.3% of patients with cervical pathology. Overall, the right ureter was significantly closer to the cervix than the left (2.0 +/- -0.8 cm vs. 2.2 +/- 1.0 cm, p < 0.05). In cases were the pathology was limited to the cervix, the right ureter was more distant than the left (2.0 +/- 0.6 cm vs. 1.7 +/- 0.6 cm, p < 0.05). The distance between the ureters and the cervix was inversely correlated with the lateral diameter of the cervix (r = 0.18, p < 0.001) and its anterior-posterior diameter (r = 0.11, p < 0.001). Age did not correlate with the distance of the ureters from the cervix (r = 0.002, p = N.S). In conclusion, approximately 10% of patients with cervical pathology can be expected to have a ureter proximate less than 5 mm from the cervix. For patients with cervical pathology undergoing a planned hysterectomy, preoperative measurement of cervical-ureteric distance may be warranted. In these circumstances intra-operative measures to protect the ureter and ascertain its integrity may be invaluable.

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Section: Discussionmentioning

confidence: 99%

A radiological study on the anatomical proximity of the ureters and the cervix

et al. 2007

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“…A cystoscopy that demonstrated bilateral ureteric jets was performed at the conclusion of the procedure. Post-procedure cystoscopy with intravenous injection of indigo carmine is increasingly used to demonstrate ureteric patency following gynaecologic surgery [17] and is routinely performed in our unit following TLH. This method, however, can still provide a false negative result in cases of urological injury secondary to thermal damage or where there is partial obstruction [17, 18].…”

Section: Discussionmentioning

confidence: 99%

The effect of patient body mass index on surgical difficulty in gynaecological laparoscopy

et al. 2010

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The objective of this pilot study was to evaluate the extent to which laparoscopic gynaecological surgery could be completed as planned in overweight and obese patients versus patients of normal weight. A prospective surgical audit was conducted of 64 women undergoing laparoscopy for benign gynaecological conditions. Patients were grouped according to their body mass index (BMI). The number of attempts required for successful laparoscopic entry, the ability to identify key surgical landmarks, the ability to complete the planned surgery, the rate of conversion to laparotomy and the complication rates were recorded. Surgery was completed as planned in 95.31% of participants. Completion rates declined with increasing BMI. Increased entry attempts and an inability to identify key surgical landmarks were associated with increased BMI, although the sample size was insufficient to provide any statistically significant conclusions. The overall complication rate was 6.25%. There was a higher mean BMI in patients with a complication; however, there was insufficient data to show a significant difference. This study suggests an association between increasing BMI and increased entry attempts for laparoscopy, increased difficulty in surgical landmark identification and an overall reduction in completion of gynaecological laparoscopy as planned.

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“…10 Cohen et al in their study has mentioned the second strategy as addressing patient-specific risk factors especially in patients undergoing hysterectomy for large uteri or who require resection of adnexal masses who are also at increased risk of ureteral injury. 11 This may be related to anatomic distortion and engorgement of the vasculature, which can make identification of the anatomic course of the ureter challenging. Less commonly, ectopic insertion of the ureter or duplication in the renal system puts a patient at increased risk of ureteral injury.…”

Section: Discussionmentioning

confidence: 99%

“…Less commonly, ectopic insertion of the ureter or duplication in the renal system puts a patient at increased risk of ureteral injury. 11 Although preoperative imaging would aid in surgical planning, such anomalies are often identified intra-operatively and the surgeon should have a high degree of suspicion when dissection reveals an anatomic variant.…”

Section: Discussionmentioning

confidence: 99%

Incidental diagnosis of asymptomatic unilateral complete duplication of ureter during total laparoscopic hysterectomy

et al. 2017

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<p>Duplication of ureter is one of the common renal abnormality frequently encountered by gynaecologist during surgeries. It occurs in approximately 1% of the population. We are reporting a case of asymptomatic unilateral (left) double ureter which was incidentally diagnosed during Total Laparoscopic Hysterectomy as it is important to know the developmental anatomy of ureter and its anatomical variants. A gynaecologist should know about the clinical significance of it as well to avoid injury to ureter during hysterectomies which is the commonly performed gynaecological surgery worldwide.</p>

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Accuracy of cystoscopy in the diagnosis of ureteral injury in benign gynecologic surgery

Cited by 67 publications

References 18 publications

A radiological study on the anatomical proximity of the ureters and the cervix

A radiological study on the anatomical proximity of the ureters and the cervix

The effect of patient body mass index on surgical difficulty in gynaecological laparoscopy

Incidental diagnosis of asymptomatic unilateral complete duplication of ureter during total laparoscopic hysterectomy

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