Urinary Tract Injury at Benign Gynecologic Surgery and the Role of Cystoscopy

Teeluckdharry, Brahmananda; Gilmour, Donna; Flowerdew, Gordon

doi:10.1097/aog.0000000000001096

Cited by 120 publications

(39 citation statements)

References 40 publications

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“…Approximately 600,000 hysterectomies 25 and 300,000 colon surgeries 26 are performed annually in the United States. The estimated ureteral injury rates in hysterectomy and colorectal surgery have been reported anywhere between 0.3% to 2.5% 2,27,28 and 0.2% to 7.6%, respectively. 29 With an average hospital stay of ∼4 days and an average cost of $31,000 per ureteral injury, 30 the economic impact in the United States alone approaches $1.1B annually.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative ureter visualization using a near-infrared imaging agent

Farnam¹,

Arms

Klaassen

et al. 2019

J. Biomed. Opt.

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The fluorescent imaging agent IS-001 was determined to be well tolerated in all subjects and has the potential to provide ureter visualization throughout minimally invasive hysterectomy procedures. This study was conducted to evaluate clinical safety and efficacy of a real-time ureter visualization technique for use during hysterectomy surgery. The study drug appears safe, is renally excreted, and allows enhanced ureter visualization when imaged with a clinically approved near-infrared sensitive endoscope. This is a first-inhuman study showing preliminary results that the drug is safe and effective during surgery for improved ureter visualization.

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Section: Discussionmentioning

confidence: 99%

Intraoperative ureter visualization using a near-infrared imaging agent

Farnam¹,

Arms

Klaassen

et al. 2019

J. Biomed. Opt.

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“…There is fivefold increased detection of injuries when cystourethroscopy is performed routinely intraoperatively during gynecological surgeries. 13 Those who believe selective cystourethroscopy only detects injuries to lower urinary tract and prevents procedure-related complications, such as urethral or bladder trauma and urinary tract infection postoperatively for cost-effectiveness and to cut short the overall duration of the surgery may miss the silent injuries which will increase the incidence of postoperative morbidity and potential litigations.…”

Section: Discussionmentioning

confidence: 99%

Role of Universal Cystourethroscopy to detect Lower Urinary Tract Injuries during Gynecological Surgery

Roy¹,

Mishra²,

Aggarwal³

et al. 2018

Journal of SAFOMS

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Objective:• To determine the incidence of urinary tract injuries during gynecological surgeries. • To explore the role of universal cystourethroscopy to detect lower urinary tract injuries during gynecological operations to reduce postoperative morbidity and its sequelae. Study design:A prospective observational study. Settings:A tertiary care center. Materials and methods:This was an observational study conducted in 163 women who underwent gynecological surgery at our department during Results: Data are classified according to demography, type, and indication of surgery performed in 163 consecutive subjects. History of previous pelvic surgery, if any, was taken into account to correlate with incidence of lower urinary tract injury intraoperatively. The ureteric and bladder injuries detected by routine intraoperative cystourethroscopy were tabulated. Intraoperatively detected rates of silent ureteric and bladder injury by cystourethroscopy are higher than obvious visually inspected injuries. We obtained intraoperatively ureteric injury rate of 0.61% and a bladder injury rate of 4.29% detected by cystourethroscopy. In two patients (1.23%), in spite of blood-stained urine in urobag, we could not detect any lower urinary tract injury. On long-term follow-up, two subjects (1.23%) attended outpatient department with ureterovaginal fistula and one subject (0.61%) developed vesicovaginal fistula. Conclusion:Use of intraoperative universal cystourethroscopy during gynecological operations should be considered routinely to detect unsuspected lower urinary tract injuries and immediate management to prevent its long-term sequelae.

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“…Intraoperative detection of ureter injuries has been reported in only 5-13% of cases ( 3 , 4 ) . Among the acute injuries of the urinary tract, ureter injuries are most difficult to recognize as there often may be few or with no symptoms ( 1 ) . Intraoperative iatrogenic ureteral injuries, if recognized during the procedure, should be repaired at that setting ( 5 ) .…”

Section: Discussionmentioning

confidence: 99%

“…Urologic complications during gynecologic surgery are uncommon but dreadful. The reported incidence of ureteral injury related to gynecologic surgery varies between 2.5% and 12.1% ( 1 ) . Pelvic ureters are retroperitoneal structures that run from the renal pelvis to the bladder that can be injured during pelvic surgery at any point along their distal course.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic repair of ureter damaged during laparoscopic hysterectomy: Presentation of two cases

Apı

Boza

Kayatas

et al. 2017

tjod

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Ureter injuries are uncommon but dreaded complications in gynecologic surgery and a frequent cause of conversion to laparotomy. Recently, a few papers reported the repair of gynecologic ureteral injuries using laparoscopy with encouraging results. In these case reports, we aimed to present two laparoscopically repaired ureter injuries during total laparoscopic hysterectomies (TLH). In the first case, the ureter was transected during the dissection of the cardinal ligament, approximately 7 to 8 cm distal to the ureterovesical junction (UVJ), and in the second case, it was damaged approximately 10 cm distal to the UVJ. Both transections were identified during surgery. The injured ureter was repaired without converting to laparotomy or additional trocar insertion. Ureteroureterostomy was performed in both cases uneventfully. Although ureteric injury is a rare complication during TLH, it can be managed by the same surgeon laparoscopically during the same procedure.

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Urinary Tract Injury at Benign Gynecologic Surgery and the Role of Cystoscopy

Abstract: Although routine cystoscopy clearly increases the intraoperative detection rate of urinary tract injuries, this systematic review of 79 mostly retrospective studies shows that it does not appear to have much effect on the postoperative injury detection rate.

Cited by 120 publications

References 40 publications

Intraoperative ureter visualization using a near-infrared imaging agent

Intraoperative ureter visualization using a near-infrared imaging agent

Role of Universal Cystourethroscopy to detect Lower Urinary Tract Injuries during Gynecological Surgery

Laparoscopic repair of ureter damaged during laparoscopic hysterectomy: Presentation of two cases

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