Possible Complications of Ureteroscopy in Modern Endourological Era: Two-Point or “Scabbard” Avulsion

Gaižauskas, Andrius; Markevičius, Marius; Gaižauskas, Sergejus; Želvys, Arūnas

doi:10.1155/2014/308093

Cited by 11 publications

(9 citation statements)

References 27 publications

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“…Furthermore, even with surgical intervention, a stringent follow-up regime is mandated [16]. These high intensity follow-up regimes are very likely to cause a marked increase in discomfort, morbidity, and even mortality from various complications like ureteral perforation or avulsion [17]. It is crucial to find a better modality to diagnose and follow up patients with a urothelial neoplasm, with higher sensitivity and specificity than current methods.…”

Section: Discussionmentioning

confidence: 99%

Semaphorin-3A levels in urine demonstrates promising sensitivity for detection of upper-tract urothelial carcinoma – a preliminary case series

Getzler¹,

Vadasz²,

Rubinstein³

et al. 2018

J. Mol. Clin. Med.

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The purpose of this study was to evaluate the utility of Semaphorin-3A (Sema-3A) as a biomarker for diagnosis and management of upper tract urothelial carcinoma, independently and in conjunction to cytology. Upper tract noninvasive urothelial carcinoma is a lifelong chronic non-curable disease. It is infamously difficult both to diagnose and to follow-up, and current non-invasive methods are commonly inadequate. Sema-3A protein levels can be measured from a simple urine test and can aid in the diagnosis and follow-up and early non-invasive tumor recurrence detection. Assigned cases for this series were those with pathologically verified upper tract neoplastic lesions. Urine samples for cytology and Sema-3A were taken on admission from all recruited patients. Sema-3A protein levels were determined using ELISA in every sample, and the tumor was graded and staged according to the 2004 WHO grading system. Descriptive and statistical analysis was performed to evaluate the performance of Sema-3A and the cytology exam. This case series included 10 patients with pathologically proven upper tract urothelial carcinoma. Sensitivity for recognizing disease was calculated as 80% for cytology, and 89% for a predetermined Sema-3A cutoff. Combining the strengths of both urine tests to a single criterion (Sema-3A > 5 or positive cytology) resulted in 100% sensitivity. In conclusion, in the current preliminary study, high levels of Sema-3A correlated with upper-tract urothelial cancer stage and displayed higher sensitivity than cytology. Combined analysis of both positive Sema-3A and cytology demonstrated 100% sensitivity. Thus, Sema-3A levels can potentially serve as a reliable biomarker for diagnosis and management for the disease, given that further dedicated studies with larger patient cohorts are undertaken.

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Section: Discussionmentioning

confidence: 99%

Semaphorin-3A levels in urine demonstrates promising sensitivity for detection of upper-tract urothelial carcinoma – a preliminary case series

Getzler¹,

Vadasz²,

Rubinstein³

et al. 2018

J. Mol. Clin. Med.

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“…As along ureteral mucosa tightly stick to the scope, the ureter brought out in an inverted fashion. 5 ( Fig. 3 ).…”

Section: Discussionmentioning

confidence: 97%

Inverted mucosa and avulsion ureteral injury in ureteroscopic procedure: A very rare complication of a common procedure in urology

Kuddah

Noegroho

Abriansyah

et al. 2021

Urology Case Reports

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An avulsion is very rare and the most serious complication that may occur during ureteroscopy in 0.06–0.45% of patients during the ureteral stone procedure. A sixty years-old female with a small stone in the upper third of the right ureter with high-grade hydronephrosis and underwent a ureteroscopy procedure. During withdrawal of the scope, the ureter was brought out in urethral meatus, with inverted fashion, nearly the whole length of the ureter was avulsed out. A nephrectomy of the right kidney was then performed. Knowledge about signs of the ureteral avulsion, pitfalls when to stop, and treatments is really important.

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“…History of prior ureteral surgeries or procedures which could have resulted in ureteral fibrosis or loss of ureteral elasticity [ 16 ]…”

Section: Discussionmentioning

confidence: 99%

Ureteral Avulsion during Semirigid Ureteroscopy: A Single-Centre Experience

Bhaskarapprakash

Karri

Velmurugan

et al. 2020

Surgery Research and Practice

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Aims. The aim of the study is to present our experience with the management of ureteral avulsions following semirigid ureteroscopy for ureteral stones. This is one of the largest series reported so far. Methods and Materials. It is a retrospective and observational study done at Sri Ramachandra Institute of Higher Education and Research over the last 18 years. Results. There were seven cases of ureteral avulsion following semirigid ureteroscopy. All patients were males with a mean age of 35.7 years. All had impacted stones, with proximal ureteric location in 6 patients and distal ureteric location in 1 patient. Five cases had two-point avulsions with loss of entire ureter. Two cases had one-point avulsion: one distal ureteric and the other mid-ureteric. Of the five cases with whole length ureteral avulsion, four were managed by classical ileal replacement of ureter and the the fifth case was managed by ileal replacement of ureter by the Yang–Monti technique. Of the two cases with one-point avulsion, one was managed by uretero-neocystostomy and the other by uretero-ureterostomy. All the patients had successful outcome. Conclusions. Even though rare, ureteral avulsion can potentially happen especially when dealing with impacted ureteric stones. Being conscious of the possible occurrence of this serious complication during any difficult ureteroscopy and exercising utmost care during the procedure are important preventive measures. However, this catastrophe can be successfully managed by either immediate definitive repair or in a staged manner.

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Possible Complications of Ureteroscopy in Modern Endourological Era: Two-Point or “Scabbard” Avulsion

Cited by 11 publications

References 27 publications

Semaphorin-3A levels in urine demonstrates promising sensitivity for detection of upper-tract urothelial carcinoma – a preliminary case series

Semaphorin-3A levels in urine demonstrates promising sensitivity for detection of upper-tract urothelial carcinoma – a preliminary case series

Inverted mucosa and avulsion ureteral injury in ureteroscopic procedure: A very rare complication of a common procedure in urology

Ureteral Avulsion during Semirigid Ureteroscopy: A Single-Centre Experience

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