Rates of Urinary Tract Injury From Gynecologic Surgery and the Role of Intraoperative Cystoscopy

Gilmour, Donna; Das, Subrata K.; Flowerdew, Gordon

doi:10.1097/01.aog.0000220500.83528.6e

Cited by 187 publications

(107 citation statements)

References 39 publications

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“…The rate of ureteral injury for vaginal hysterectomy is 0.2 injuries per 1000 cases, and 1.3 injuries per 1000 cases for total abdominal hysterectomy [Gilmour et al 2006]. It has been suggested that this difference in rates between procedures is a result of the selection bias towards transabdominal hysterectomy for cases complicated by infection, previous surgery, and malignancy [Elliott and McAninch, 2006].…”

Section: Gynecologic Surgerymentioning

confidence: 99%

Management of iatrogenic ureteral injury

Burks

Santucci

2014

Therapeutic Advances in Urology

207

160

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Iatrogenic injury to the ureter is a potentially devastating complication of modern surgery. The ureters are most often injured in gynecologic, colorectal, and vascular pelvic surgery. There is also potential for considerable ureteral injury during endoscopic procedures for ureteric pathology such as tumor or lithiasis. While maneuvers such as perioperative stenting have been touted as a means to avoid ureteral injury, these techniques have not been adopted universally, and the available literature does not make a case for their routine use. Distal ureteral injuries are best managed with ureteroneocystostomy with or without a vesico-psoas hitch. Mid-ureteral and proximal ureteral injuries can potentially be managed with ureteroureterostomy. If the distal segment is unsuitable for anastomosis then a number of techniques are available for repair including a Boari tubularized bladder flap, transureteroureterostomy, or renal autotransplantation. In rare cases renal autotransplantation or ureteral substitution with gastrointestinal segments may be warranted to re-establish urinary tract continuity. Laparoscopic and minimally invasive techniques have been employed to remedy iatrogenic ureteral injuries.

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Section: Gynecologic Surgerymentioning

confidence: 99%

Management of iatrogenic ureteral injury

Burks

Santucci

2014

Therapeutic Advances in Urology

207

160

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“…Urinary tract injuries are reported in approximately 1 percent of women who undergo pelvic surgery 16. In our series, 2.3% of women had urinary tract injuries (7 bladder injuries, 3 ureteric injuries).…”

Section: Resultsmentioning

confidence: 50%

Laparoscopic Gynaec Surgeries – A Retrospective Study

Bansal¹,

Meenal²,

Hiremath³

et al. 2013

jemds

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BACKGROUND:There has been a rapid worldwide adoption of laparoscopic procedures across many surgical specialties, most notably in Gynaecology. Unfortunately, the increased adoption of laparoscopic surgery has also been accompanied by a corresponding rise in the rates and types of complications reported. AIMS: To audit the different types of laparoscopic surgeries and their complications and comparison with other routes of surgery. METHODS & MATERIALS:We have retrospectively analysed 285 laparoscopic surgeries and 306 other routes of surgery which were done at our institute from July 2011 to April 2013.We admit the patients 1-2 days prior to surgery and a complete medical work-up of the patient is done for elective laparoscopic surgery .We defer laparoscopy for malignant conditions, uterine size more than 20 weeks, cervix flushed to the vagina or with history of more than 2 pelvic surgeries. Sub-fertile women, after an initial workup, are subjected to diagnostic laparoscopy with chromopertubation.

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“…Contrast-enhanced CT with delayed imaging, CT cystography, and retrograde urethrography are the diagnostic imaging studies of choice for these JAYPEE injuries. 51 CT cystography with retrograde filling of the bladder followed by helical CT acquisitions is reported to have a 97% sensitivity and 100% specificity for intraperitoneal leakage and 78% sensitivity and 99% specificity for intraperitoneal leakage. Fistulas can also be diagnosed with this method.…”

Section: Postpartum and Postsurgical Complicationsmentioning

confidence: 99%

Imaging Modalities in Gynecology

Busse¹

2010

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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REVIEW ARTICLE DSJUOG ULTRASOUNDTransabdominal gynecologic ultrasound combined with transvaginal scanning is a technique that was initially introduced in the early 1980's and quickly became a "musthave" procedure for gynecologists and emergency room physicians for assistance in diagnosing many gynecologic conditions. Rapid advances in the quality of the equipment, techniques used to obtain best images, and research designed to help physicians interpret their findings have contributed to ultrasound's quick rise in use and popularity. It is ubiquitous that ultrasound is the imaging modality of choice for gynecologic conditions.The advantages of ultrasound are numerous. It is fast, easy to obtain, has a high patient tolerance and is relatively inexpensive when compared to CT and MRI. Many physicians' offices have ultrasound machines that are more than sufficient to make common diagnoses thereby alleviating patient anxiety and physician concerns if an abnormality is found during a physical exam. Appropriate referrals and treatments can be initiated in a timely manner at minimum expense. The ability to use the transvaginal ultrasound as an extension of a pelvic exam is extremely useful, particularly when the source of pain is uncertain during bimanual exam or if a mass is found of uterine or ovarian origin. An obvious advantage, especially when compared to CT, is that no radiation exposure occurs. As will be discussed in more detail, pelvic ultrasound has been shown, in numerous studies, to have a high negative predictive value and offers excellent resolution of the uterus and adnexal structures, especially when compared to CT and MRI.There are disadvantages; however, that should be addressed. Even with routine use of transabdominal scanning which utilizes the acoustic window of a full bladder, the field of view is very limited, especially, compared to CT and MRI. Transvaginal sonography limits the field; however, it is effective in obtaining excellent resolution of the uterus, endometrium and adnexal structures. Ultrasound visualizes the bowel poorly and it is well-known that bowel gas corrupts the ultrasound signal allowing for potential "missed" masses not visible under the bowel. An additional drawback is that poor contrast occurs between dissimilar tissues (i.e. blood and fat) making it difficult to characterize certain ovarian masses accurately.Ultrasound characterizes gynecologic pathology extremely well. Fibroids, endometriomas, dermoids, masses that are suspicious for malignancy, uterine anomalies, IUD complications, ectopic pregnancies, and endometrial pathology (with the help of transvaginal saline infusion sonography) are diagnoses that are detected with high accuracy. The following will give illustrations of the clinical utility of diagnostic gynecologic ultrasound for specific clinical conditions. AbstractAlthough ultrasound is the primary imaging modality for most gynecologic diagnoses and conditions, knowledge of other diagnostic imaging procedures is important to gynecologists, emergency room physici...

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Rates of Urinary Tract Injury From Gynecologic Surgery and the Role of Intraoperative Cystoscopy

Abstract: The reasons for higher injury detection rates when routine cystoscopy was performed are unclear. Further study is needed to identify the scenarios where routine cystoscopy is warranted after major gynecologic surgery.

Cited by 187 publications

References 39 publications

Management of iatrogenic ureteral injury

Management of iatrogenic ureteral injury

Laparoscopic Gynaec Surgeries – A Retrospective Study

Imaging Modalities in Gynecology

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