More Issues Per Year (original) (raw)
Related papers
Iatrogenic ureteral lesions and repair: A review for gynecologists
Journal of Minimally Invasive Gynecology, 2007
Ureter injuries are a well-known complication of gynecologic surgery and a frequent cause of medicolegal problems. Because there are no randomized, controlled trials and the available studies are small series and case reports, the evidence on which to base treatment is weak. We therefore reviewed the complete English-language literature of ureter repair since 1990. In total, 608 ureter injuries were reported. Although it is widely believed that for laceration or section the prognosis is affected by a delay in diagnosis, we could not find evidence to substantiate this. An obstruction requires stenting only. For a laceration, stenting with suturing was more effective than stenting only (p ϭ .006). A ureter anastomosis was successful in over 94% of cases either by laparotomy or laparoscopy. In conclusion, the literature data are scanty and heterogeneous and do not permit solid conclusions. Evidence, however, is emerging that a laceration should be treated by stenting and suturing. A ureter anastomosis over a stent could become a valid option especially when performed by laparoscopy.
Immediate and late management of iatrogenic ureteric injuries: 28years of experience
Arab Journal of Urology, 2015
Objective: To evaluate the long-term results after managing intraoperative and late-diagnosed cases of iatrogenic ureteric injury (IUI), treated endoscopically or by open surgery. Patients and methods: Patients immediately diagnosed with IUI were managed under the same anaesthetic, while those referred late had a radiological assessment of the site of injury, and endoscopic management. Open surgical procedures were used only for the failed cases with previous diversion. Results: In all, 98 patients who were followed had IUI after gynaecological, abdominopelvic and ureteroscopic procedures in 60.2%, 14.3% and 25.5%, respectively. The 27 patients diagnosed during surgery were managed immediately, while in the late-referred 71 patients ureteroscopic ureteric realignment with stenting was successful in 26 (36.6%). Complex open reconstruction with re-implantation or ureteric substitution, using bladder-tube or intestinal-loop procedures, was used in 27 (60%), 16 (35.5%) and two (4.5%) patients of the late group, respectively. A long-term radiological follow-up with a mean (range) of 46.6 (24.5-144) months showed recurrent obstruction in 16 (16.3%) patients managed endoscopically and reflux in six (8.3%) patients. Three renal units only (3%) were lost in the late-presenting patients. Conclusion: Patients managed immediately had better long-term results. More than a third of the late-diagnosed patients were successfully managed endoscopically
Complications of Ureteroscopic Approaches, Including Incisions
Current Clinical Urology, 2006
Ureteroscopy has progressed from cystoscopic examination of a dilated ureter in a child in 1929 and the initial use of rigid ureteroscopes in the 1980s, to its current state of small caliber semirigid and flexible instruments. In this chapter the authors review complications of ureteroscopy including those associated with incisional techniques where one would anticipate a higher incidence of complications. They review the history and development of modern ureteroscopes, focusing on engineering advances. Clinical points made include proper patient selection and preparation; proper use of dilators, wires, and ureteral access sheaths; and the incidence, identification, and management of complications associated with ureterorenoscopy (both intraopertively and postoperatively).
Outcome of Laparoscopic Repair of Ureteral Injury: Follow-Up of Twelve Cases
Journal of Minimally Invasive Gynecology, 2012
To review the feasibility of laparoscopic repair in cases of ureteral injuries occurring during gynecologic laparoscopy. Design: Retrospective study (Canadian Task Force classification II-3). Setting: Institution-specific retrospective review of data from a tertiary referral medical center. Patients: Patients suffering from iatrogenic ureteral injuries diagnosed during or after surgery, and cases with deliberate ureteral resection and repair because of underlying disease. Measurements and Main Results: We conducted a retrospective review of all (10 345) laparoscopic gynecologic surgeries performed in our institute between February 2004 and November 2008. Twelve cases (median: 45.5 years, range: 27-63) of ureter transections were diagnosed and repaired laparoscopically by endoscopists. Of these, 10 had previous surgeries, pelvic adhesions, or a large pelvic-abdominal mass. One patient had undergone a segmental resection and laparoscopic ureteroureterostomy for deep infiltrative endometriosis. Of the remaining 11 iatrogenic ureteral transections, 10 were repaired via laparoscopic ureteroureterostomy, whereas 1 had undergone a laparoscopic ureteroneocystostomy. One injury was recognized on the second postoperative day, but intraoperative recognition was attained in 11 cases. The median duration of double J stenting was 73 days. Three patients had development of strictures (between 42 and 79 days after surgery) treated with restenting, but 1 had to undergo an ureteroneocystostomy for ureter disruption when trying to restent. One patient had development of leakage of the anastomotic site but recovered with a change of the double J stent. Only 1 case required another laparotomy for ureteroneocystostomy. Laparoscopic primary repair of ureteral injury was successful for 11 of 12 patients. All the patients were well and symptom free at the conclusion of the study period. Conclusion: Early recognition and treatment of ureteral injuries are important to prevent morbidity. Laparoscopic ureteroureterostomy could be considered in transections of the ureter where technical expertise is available. To the best of our knowledge, this is the largest series, to date, of ureteral repairs via laparoscopy.
Laparoscopic and retroperitoneoscopic repair of ureteropelvic junction obstruction
Urology, 1996
Objectives. The aim of this study was to evaluate laparoscopic and retroperitoneoscopic pyeloplasty and to compare the efficacy of dismembered and nondismembered techniques. Methods. Since May 1993, a modified laparoscopic transperitoneal (14 patients) and a retroperitoneoscopic approach (3 patients) have been used for the management of ureteropelvic junction obstruction.
International Journal of Surgery Case Reports, 2019
To expose the diagnosis and the different laparoscopic approaches for the surgical management of patients with retrocaval ureter (RCU) and to share our experience on two cases. METHODS: Updated literature review on Pubmed and debating personal experiences including ours (double j stent insertion before the surgery, use of 4 trocards, transperitoneal approach, pyelopyelostomy for the anastomosis.. .), concerning the laparoscopic treatment of the RCU. RESULTS: Laparoscopic treatment of RCU is a recommended management for many reasons: less blood loss during the surgery, a shorter hospital stay, less postoperative pain and superior esthetic results with excellent functional results. All of these findings were also a part of our experience on the two reported cases: operative time was 210 and 180 min with no significant bleeding, hospital stay was 48 h post operatively for both patients that were symptom free with no renal dilation after 2 years of close follow up. The main cause of the increased operating time is the intracorporeal anastomosis of the ureter which remains the main limiting factor of the laparoscopic surgery. CONCLUSIONS: The literature review has clearly shown the advantages of minimally invasive techniques for the treatment of retrocaval ureter. Pure laparoscopic treatment (as in our two cases), seems feasible and technically reliable, and should be the standard surgical option for the treatment of RCU.
Laparoscopic ureterolysis and reconstruction of a retrocaval ureter
Surgical Endoscopy, 2003
A 32-year-old man was investigated for repeated episodes of right-sided flank pain. Ultrasonography showed a dilated right pelvicalyceal system and upper ureter as well as multiple gallstones; subsequent intravenous urogram demonstrated a retrocaval ureter. At surgery, a right-sided double-J ureteric stent was placed under fluoroscopic guidance. Initially, three 8/14/2014 Laparoscopic ureterolysis and reconstruction of a retrocaval ureter -Springer http://link.springer.com/article/10.1007/s00464-003-4513-5/fulltext.html 2/12
Laparoscopic Repair of a Ureter Damaged During Inguinal Herniorrhaphy
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2008
Background: Laparotomy has been used generally to deal with ureteral injury. Recently, a few papers have reported the repair of gynecologic ureteral injuries by laparoscopy, with encouraging results; however, successful repair of a ureter damaged during an open inguinal herniorrhaphy fully performed by laparoscopy has not been reported yet. Patient: A 49-year-old obese man (body mass index = 35) in the 10 years before surgery began to note a protrusion in the scrotal region. The protrusion evolved asymptomatically for 8 years, and began to cause pain in the lumbar spine to the right and paresthesia of the right leg. Method: An open right inguinal herniorrhaphy was performed. When the exeresis of the fatty tissue around the spermatic cord was being carried out, resection of a 12-cm tubular structure, supposedly the appendix, was performed. Wall defect was closed by a polypropylene mesh. Acute abdominal pain developed immediately in the postoperative period and investigation using laparoscopy was undertaken. After confirmation of ureteral injury, laparoscopic repair was performed, and the ureter was anastomosed without tension over a double-J catheter. A suction drain was left near the anastomosis. Result: Postoperative period was uneventful. The vesical catheter was withdrawn on the eighth postoperative day and the drain on the twelfth postoperative day. The histopathologic report confirmed that the resected structure was the ureter. The patient has remained asymptomatic for 2 years since the surgery.