Early Repair of Iatrogenic Injury to the Ureter or Bladder after Gynecological Surgery

Blandy, J. P.; Badenoch, D. F.; Fowler, C. G.; Jenkins, B. J.; Thomas, Nicholas

doi:10.1016/s0022-5347(17)37915-6

Cited by 162 publications

(81 citation statements)

References 16 publications

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“…Most injuries were associated with attempts to achieve haemostasis without properly identifying the ureter [98]. In all vaginal hysterectomies, Grade 4 cystocele repairs, enterocele repairs, and bladder neck suspensions, ureteric integrity should be assessed with intravenous indigo carmine [57,58,60]. When no indigo is cystoscopically observed from the ureteric orifice, a ureteric stent should be placed.…”

Section: Suture Ligation Injurymentioning

confidence: 99%

Diagnosis and management of ureteric injury: an evidence‐based analysis

Brandes¹,

Coburn²,

et al. 2004

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The Consensus on Genitourinary Trauma continues this month with an evidence‐based analysis, by a team of experts under the chairmanship of Dr Jack McAninch, of current reports on the diagnosis and management of ureteric trauma. This is quite a unique document, and of interest to all urologists; not only as a consensus on how this condition should be managed, but also as a model of how to review current publications.

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Section: Suture Ligation Injurymentioning

confidence: 99%

Diagnosis and management of ureteric injury: an evidence‐based analysis

Brandes¹,

Coburn²,

et al. 2004

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“…Therefore, an attempt to introduce a JJ stent immediately after making a delayed diagnosis of ureteral injury should be the treatment of choice in most patients and as proven by our material also later than 14 days after an injury. It is not always possible to accomplish this procedure for technical reasons and despite repeated attempts a stent cannot always be introduced above obstruction using an ascending route [15][16][17][18][19][20]. If an attempt to catheter- ize failed or it has not been made, the formation of renal fistula is the next or initial step of management.…”

Section: Discussionmentioning

confidence: 99%

“…These patients should not await reconstructive surgery for several months under the PN cover, but depending on their clinical condition should be operated much sooner if not immediately after making a diagnosis of ureteral injury. Many reports indicate that such treatment is as effective as postponed surgery [15,17,18,[22][23][24][25][26][27]. A prompt reoperation, which couldn't be avoided anyhow in those cases, makes the patient to recover faster.…”

Section: Discussionmentioning

confidence: 99%

Evolution in the approach to overlooked ureteral injuries after gynecological surgery

et al. 2016

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Objectives: To analyzed the therapeutic results for patients with overlooked iatrogenic ureteral injuries after gynecological surgery, treated at the department since 1990. Before the era of endourology, ureteral injuries were operated on immediately after making a diagnosis. This approach was changed after the popularization of percutaneous nephrostomy (PN) and ureteral stenting using a JJ stent. Material and methods:27 patients who were diagnosed with a ureteral injury between the first and sixty-fourth day after injury were included. Only PN was performed in 21 patients (group A). In 6 patients, a JJ stent was introduced either immediately after making a diagnosis or after PN (group B). Results:In group A, a good therapeutic result was obtained in only 6 patients (28.6%). Of the 12 patients subjected to PN up to two weeks after injury, 5 had a good result without a need for repair surgery. Of the 9 patients with an injury diagnosed after 3 weeks, only one had a good therapeutic outcome. In Group B, a good result was achieved in 5 out of 6 patients. In 2 patients, a JJ stent was introduced immediately after making the diagnosis, and, in 3 patients, after PN. A successful attempt to "tunnelize" a complete and long obstruction in the sixth patient failed. Conclusions:Attempting to introduce a JJ stent should be the treatment of choice in patients with an overlooked iatrogenic ureteral injury. If an attempt to introduce the JJ stent fails, PN should be performed as a first step to manage the injury.

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“…Some authors endorse immediate operative repair of all iatrogenic ureteral injuries, regardless of the postoperative interval, to lessen the incidence of ureteral stricture, fistula and urinoma formation. 15,16 Others believe that for delayed recognition injuries, initial urinary diversion can protect the kidney and allow resolution of any local hematoma, urinoma or inflammatory reaction. 14,17,18 Ghali and colleagues compared 24 primary open repairs versus 7 staged procedures (urinary decompression with subsequent definitive surgical reconstruction) for iatrogenic ureteral injury and found similar overall complication rates of 25% and 29%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Hand-assisted laparoscopic ureteroureterostomy with renal mobilization for delayed recognition of a proximal ureteral injury after lumbar disk surgery

Kaffenberger

Tomaszewski

Tsao

et al. 2013

CUAJ

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We present hand-assisted laparoscopic ureteroureterostomy (HALUU) with renal mobilization as a novel approach to the management of proximal ureteral injury after lumbar disk surgery. A 63-year-old female underwent L4-L5 diskectomy and facetectomy with cage placement for back and leg pain. Postoperatively, she developed fever, nausea, abdominal pain, ileus and leukocytosis. A computed tomography scan of the abdomen and pelvis with intravenous contrast and delayed imaging demonstrated a left proximal ureteral injury with contrast extravasation. Retrograde and antegrade ureteral stent placement was unsuccessful; a nephrostomy tube was placed. Antegrade and retrograde ureterograms revealed a 3-cm proximal ureteral defect. All treatment options were discussed, and the patient chose to undergo hand-assisted laparoscopic renal mobilization with ureteroureterostomy, which was completed successfully without complications. Operative time was 381 minutes; estimated blood loss was 50 mL. The patient was discharged after 2 days, her ureteral stent was removed in 8 weeks, and follow-up with furosemide-mercaptoacetyltriglycine (MAG-3) renal scan demonstrated 30% function without evidence of obstruction. Hand-assisted laparoscopic ureteroureterostomy with renal mobilization can be performed as definitive management of a medium-length proximal ureteral injury. This is the first case describing this management technique after lumbar disk surgery.Can Urol Assoc J 2010;4(3):E82-E85

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Early Repair of Iatrogenic Injury to the Ureter or Bladder after Gynecological Surgery

Cited by 162 publications

References 16 publications

Diagnosis and management of ureteric injury: an evidence‐based analysis

Diagnosis and management of ureteric injury: an evidence‐based analysis

Evolution in the approach to overlooked ureteral injuries after gynecological surgery

Hand-assisted laparoscopic ureteroureterostomy with renal mobilization for delayed recognition of a proximal ureteral injury after lumbar disk surgery

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