These injuries, however, do occur in routine as well as complicated surgical cases. Prevention of ureteral injuries in gynecologic surgery. Bladder injury, ureteral injury, obstetric and gynecologic surgery, iatrogenic diseases. Ureteral injury occurred in 1,753 of 223,872 patients 0.
In 2005, vakili and colleagues performed a prospective, multicenter study examining ureteral injury at the time of hysterectomy based on universal cystoscopy. Early and late diagnosis of iatrogenic urinary tract injuries. Ureteral injuries were recognized intraoperatively in 20 patients and 1 to 28 days after the surgery in 15 patients. Cystoscopy and ureteral stents for the gynecologic surgeon. Learning objectives learner will be able to understand.
Less common than injuries to the bladder or rectum, ureteral injuries are far more serious and troublesome and often are associated with a high morbidity, the formation of ureterovaginal fistulas, and the potential loss of kidney function, especially when recognized postoperatively. The reported incidence of ureteral injury during gynecologic surgery is relatively low. Iatrogenic ureteral injury may result from any of the following. The incidence of ureteral injury is much higher during abdominal hysterectomy than vaginal hysterectomy.
The ureters are most often injured in gynecologic, colorectal, and vascular pelvic surgery. Results a total of 5729 colectomies were performed during the study period. Injury to the ureter is one of the most serious complications of gynecologic surgery. Postoperatively, patients with ureteral injury typically present with costovertebral angle tenderness, ileus, fever, and flank pain with a minimal rise in serum creatinine. Damage to a ureter during a gynecological surgical procedure will most likely be due to the surgeons misidentification of the. Although injury to the ureters during laparoscopic surgery is infrequent, 38% occur during the treatment of endometriosis. How to prevent ureteral injuries during pelvic gynecological. Gynecologic, general surgical, and urologic procedures, especially in the pelvis, put the ureter at risk for injury. Ureter injuries are associated with an incidence of 0. Many studies assessing the incidence of uret eral injuries in gynecologic procedures detail ureteral injury rates ranging from 0.
Early and late diagnosis of iatrogenic urinary tract injuries during. Gynecological surgery remains by far the most common means of injury 75%, followed by colorectal surgeries 14% 35, with reports of ureteral injury during gynecologic surgery from 0. Table 1 outlines the risk of ureteric injury associated with various obstetric and gynaecological procedures. Ureteral catheter placement for prevention of ureteral injury. Epidemiology and prevention and management of intraabdominal, pelvic, and genitourinary complications of colorectal surgery, section on ureteral injury. Ureteral injury in laparoscopic gynecologic surgery. Therefore, surgeons should be cautious to prevent ureteral injury during gynecologic surgery, especially in patients with risk factors. Feb 09, 2012 ureteral injuries during gynecologic surgery.
Ten women had symptoms suggestive of ureteral obstruction during the immediate postoperative period 5 days1 week after surgery. Mar 01, 2012 main outcome measures a significant increase in ureteral injuries occurred after laparoscopic vs open procedures 0. Surgical management of the ureter is dictated by the location of the ureteral injury. The majority of ureteral injuries are iatrogenic in nature 5. Ureteral injury is one of the most serious complications of gynecologic surgery. Ureteral injuries during gynecological surgery request pdf. Jan 07, 20 iatrogenic ureteric injury is a known and dreaded complication of surgery by obstetricians and gynaecologists, and is associated with significant morbidity and implications for litigation. Identification and management and urinary tract injury in gynecologic surgery.
An unrecognized or mismanaged ureteral injury can lead to significant complications including urinoma, abscess, ureteral stricture, and potential loss of ipsilateral kidney or even death. Abstract pelvic surgery is the most common cause of iatrogenic ureteral injury. Intraoperative injury to the ureter is possible not only during complicated surgical procedures but also during uncomplicated procedures. It is very important to be familiar with presentation, diagnostic methods and management as well as prevention of ureteral injury at the time of gynecologic laparoscopy. Feb 20, 2012 the incidence of ureteral injury was significantly higher in cases having risk factors than in cases without risk factors. Reteral injury is a serious concern during abdominal and pelvic surgery and represents one of the most dreaded complications during gynecologic operations, with an overall incidence ranging from 0. Fourteen ureteral injuries occurred, resulting in a 0. Pdf ureteral injury in laparoscopic gynecologic surgery. Prevention of ureteral injuries in gynecologic surgery american.
Ureteral catheter placement for prevention of ureteral injury during laparoscopic hysterectomy yudai tanaka1, hironori asada 2, naoaki kuji and yasunori yoshimura 1department of obstetrics and gynecology, yazaki hospital, kanagawa, and 2department of obstetrics and gynecology, keio. Prevention, identification, and treatment of complications are predicated on liberal use of cystoscopy. While ureteral injuries are an uncommon surgical complication, it is estimated that 5282% of iatrogenic injuries occur during gynecologic. Conventionally, the most frequently injured organ during gynecologic operations is bladder and the rate of injury was reported as 0. Ureteral injury is one of the complications inherent in any gynaecological pelvic surgery. Pdf ureteric injury in obstetric and gynaecological surgery.
We provide a discussion on the diagnosis and management of ureteral injury after gynecological surgery. During hysterectomy, the ureter is susceptible to injury as it passes through the parametrium a short distance from the uterus and vaginal fornix. Gynecologists should be aware of urologic injury during surgery and should always take preventive measures. Iatrogenic ureteral injury after gynecological surgery. However, ureteral injuries can occur during any abdominopelvic. Dec 28, 2018 ureteral injury is one of the most serious complications of gynecologic surgery. Bladder and ureteral injuries during benign hysterectomy. Pdf ureteral injuries during gynecologic procedures. Bladder injuries may occur during pelvic, abdominal or vaginal operations. Ureteric injury during obstetric and gynaecological surgery. At least 50% of ureteral injuries reported during gynecologic surgery have occurred in the absence of a recognizable risk factor. Incidence of ureteral injuries gynecologic surgery while ureteral injuries are an uncommon surgical complication, it is estimated that 5282% of iatrogenic injuries occur during gynecologic surgery lee et al. Less common than injuries to the bladder or rectum, ureteral injuries are far more serious and troublesome and are often associated with significant morbidity, the formation of ureterovaginal fistulas, and the potential loss of kidney function, especially when re.
During any pelvic surgery, the surgeon must have a thorough knowledge of the location of the ureter and the specific locations where it is most susceptible to injury to prevent ureteral injuries. Original research urologic injury and fistula after hysterectomy for benign indications kai b. Ureteric injuries during gynaecological surgery ppt dr rahul s. Clinicians should have a high suspicion for ureteral injury in the presence of postoperative fever, flank pain, leukocytosis, and peritonitis. Pelvic surgery demands proficiency in all aspects of endoscopy. Pdf to report the safety and efficacy of percutaneous nephrostomy and primary antegrade recanalization for treatment of iatrogenic ureteral strictures. In fact, 75% of all ureteral injuries occur during gynecologic surgery, with the majority of these injuries occurring during abdominal procedures. How to safeguard the ureter and repair surgical injury. Estimated incidence of ureteral injury during laparoscopic hysterectomy is 2. Benson 1 stephanie thompson 1 gen li 2 denise asafu. Preoperative evaluation is useful in identifying patients who are at higher risk of ureteral injury, although it has been reported that half of all patients with ureteral injuries have no risk factors. Early recognition and repair of damage to the urinary tract are essential for optimal patient outcome and for preventing late consequences e. Cost analysis of prophylactic intraoperative cystoscopic. The anatomic proximity of the ureters to the genital tract places them at risk of injury during pelvic surgery, which could damage to renal function.
Prophylactic intraoperative ureteral stents have been used during conduit surgery,1renal transplant,1ureteroscopy. They occur in straightforward as well as complicated cases, to both experienced and neophyte. Ureteral injuries during the course of surgical procedures within the pelvis occur. To explore the rates and risk factors for sustaining a genitourinary injury during hysterectomy for benign indications. To report the safety and efficacy of percutaneous nephrostomy and primary antegrade recanalization for treatment of iatrogenic ureteral strictures after gynecologic surgery. Ureteric injury in gynaecologic cancer surgery part 1 duration. The diagnosis and management of ureteric injury after. Less common than injuries to the bladder or rectum, ureteral. When injury is discovered during surgery, correction of the injury can be repaired with minimal risk of longterm sequelae. Incidence of iatrogenic ureteral injury after laparoscopic. We investigated preoperative ureteral catheter uc placement as a way to prevent ureteral injury in laparoscopic. How to prevent ureteral injuries during pelvic gynecological procedures vito leanza1, antonia francesca di prima2, gianluca leanza3, maria cristina teodoro4, antonio carbonaro5, alfio dagati6 and carlo pafumi7.
The following injuries occurred during gynecological surgery. Ureteral injuries in gynecologic surgery springerlink. Although ureteral injury can be recognized intraoperatively and managed appropriately without any sequelae. There is also potential for considerable ureteral injury during endoscopic procedures for ureteric pathology such as tumor or lithiasis. Ureteric injury in gynecological surgery the intraoperative diagnosis of ureteric injury remains a challenge. Gynecologic surgery and ureteral damage a question of. Complications of recognized and unrecognized iatrogenic ureteral. From 5122 major gynecologic operations we found 18 cases of ureteric injury, including 4 cases of urinoma. In fact, 75% of all ureteral injuries occur during gynecologic surgery, with the majority of these injuries. Iatrogenic injury to the ureter is a potentially devastating complication of modern surgery. Cystoscopy and ureteral stents for the gynecologic surgeon didactic paul d. The approximate rate of ureteral injury during major gynecologic surgery is 1%. Ureteral injury in laparoscopic gynecologic surgery ncbi.
The diagnosis and management of ureteric injury after laparoscopy. Ureteric injury in obstetric and gynaecological surgery. Iatrogenic ureteral injury can occur in many different settings, however, the majority occur in the context of gynecological procedures. Although the reported incidence of iatrogenic ureteral injuries during gynecologic surgery varies widely from 0. We present a case of a ureteral injury during vaginal hysterectomy for severe pelvic organ prolapse.
Cystoscopy, like laparoscopy, is a technology that should benefit our patients and not isolate a specialty. Pdf ureteric injury is rare in obstetric and gynaecological practice but, when it occurs, it has serious implications in terms of both morbidity. Ureteral injury is among the most devastating complications of gynecologic surgery. Crushing suture ligation devascularization electrocautery cryoablation avulsion transection gynecologic surgery abdominal hysterectomy was once the most common cause of iatrogenic ureteral injury see the image below. For the 35 patients with diagnosed iatrogenic ureteral injuries, gynecologic surgeries had been performed for malignant n27 or benign n8 pelvic disease. Ureteral injuries during gynecological surgery springerlink. Ureteral injuries are rare but potentially devastating complications of all major gynecologic operations. Ureteral injury is one of the serious complications of laparoscopic surgery, in particular, gynecologic laparoscopy. Litigation following ureteral injuries associated with gynaecological. In gynecologic surgery, ureteral injury occurs most often during abdominal hysterectomyprobably because of how frequently this operation is performed and the range of pathology managed.
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