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Introduction. Iatrogenic trauma of the ureters accounts for 1-5.7% of all injuries to the organs of the genitourinary system, it is this that presents the greatest difficulty for diagnosis and the greatest danger in terms of the rate and frequency of development of severe, life-threatening complications (phlegmon of the retroperitoneal space, urinary peritonitis, sepsis. Description of the clinical case. Patient A., 47 years old. On June 17, 2019, laparoscopic uterine extirpation was performed for fibroids. 06/22/2019, iatrogenic injury of the lower third of the left ureter was diagnosed. Percutaneous puncture nephrostomy on the left was performed as the first stage for urine diversion. At the second stage, ureteroscopy on the left was performed, in which a burn zone was determined in the lower third of the left ureter, up to 0.5 cm in length with a defect of 1/3 of the ureteral circumference. Left kidney stenting was performed. After 2 months, the ureteral stent was replaced. At control computed tomography (4 months after surgery), the left ureter was contrasted along the entire length, no urodynamic disturbances were revealed. Discussion. Open surgical interventions for iatrogenic trauma of the ureter are long and traumatic, require a long rehabilitation period, accompanied by social maladjustment of patients, therefore the use of X-ray endoscopic methods of treatment is an effective and alternative method of treating this pathology. Conclusion. In this case, timely detection of iatrogenic damage to the ureter made it possible to perform an effective minimally invasive surgical treatment, which saved the patient from possible severe complications.

Objective To determine the safety and efficacy of the one-surgeon basketing technique for stone extraction during flexible ureteroscopy when carried out by novice surgeons under instructor guidance. Methods We retrospectively compared perioperative results, complications and the "stone-free" rate (defined as ≤2 mm fragments on kidney-ureter-bladder imaging 1 month after flexible ureteroscopy) between experienced (group A, n = 50) and novice (group B, n = 50) surgeons using the one-surgeon basketing technique. Results Baseline patients' characteristics were similar between the two groups. There were no significant differences between groups A and B in operative time (mean 76 min vs 85 min, P = 0.46), stone-free rate (98% vs 92%, P = 0.36), postoperative fever events (4% vs 4%, P = 1.00) and postoperative hospital stay (24 h vs 24 h, P = 1.00). Clavien-Dindo grade IIIa complications (ureter injury) were only observed in two cases (4%) in group B. Conclusions The one-surgeon basketing technique for the extraction of stone fragments during flexible ureteroscopy might be safely and effectively carried out by surgeons with no prior experience under proper guidance.

Introduction and importance Placenta accreta spectrum (PAS) is a state of abnormal attachment of the placenta, including placenta accreta, placenta increta, and placenta percreta. This condition can be life-threatening due to the placenta cannot spontaneously separated, resulting in continuous bleeding. Cesarean section followed by hysterectomy is one of the treatment options for PAS. There was a great liability for urinary tract injuries during the operation of PAS patient. Case presentation We present the case of ureter injury during subtotal hysterectomy in patient with PAS. A 30-years-old female patient was diagnosed with recurrent antepartum hemorrhage due to placenta previa accreta spectrum on G2P1 33 weeks of gestational age, singleton live breech presentation, previous c-section 1×. After uterine transverse incision, the baby was delivered. We decided to perform subtotal hysterectomy. There was severe adhesion. On the exploration after subtotal hysterectomy was performed, we found ruptured of the right ureter. Clinical discussion Hysterectomy peripartum is one of the treatment of PAS, either to prevent or to control postpartum hemorrhage. In pregnant women with morbid placental adherence, there was a great liability for urinary tract injuries. Distal ureters are the most commonly injured while hysterectomy. Injuries to the ureters in this patient occurred due to severe adhesions and unclear visual organ. Conclusion Although it is rare, ureter injury may occur during subtotal hysterectomy in patient with placenta accreta spectrum. To prevent that condition, inserting ureter stent can be perform before the operation. Multidisciplinary approach is carried out so that patient outcomes are good., Highlights • Ureter injury in obstetrics hysterectomy: case report • Ureter injury in placenta accreta spectrum • Ureter injury in obstetric hysterectomy with placenta accreta spectrum

Background: To present our experience and results with the transvesical laparoscopic diverticulectomy, developed by Pansadoro et al. [BJU Int. 2009;103(3):412–24], as treatment of symptomatic bladder diverticula, with a medium-term follow-up. Methods: Between June 2010 and July 2018, we successfully operated 15 patients (13 male/2 female), aged 32–85 years (mean age 61 years) in 2 centers in Austria, using the aforementioned technique. Results: The median operative time was 297 min (range 83–488 min), and the blood loss was minimal. The median diameter of the diverticula was 94 mm (range 40–110 mm). The transurethral catheter was removed in most patients on day 7 (range 1–26 days), and cystography was performed before catheter removal. Patients were discharged on the ninth postoperative day (range 4–18 days). One case had a Clavien-Dindo grade IIIb complication (ureter injury), and 2 cases had a grade IIIa complication (nephrostomy drainage). After a median follow-up of 19 months, no recurrences were observed. Conclusion: The laparoscopic, transvesical diverticulectomy is a feasible and valuable procedure with good outcomes. To avoid complications, the ureter needs to be spared meticulously.

Hardy and colleagues carried out Renal autotransplantation for the first time in 1963 to treat severe ureter injury and it has evolved as a method used for complex treatment of trauma, renal artery diseases or ureteral stenosis. In case of proximal ureter injury, approximately 2/3 of which is iatrogenic, if the end-to-end anastomosis is not possible, renal autotransplantation, ileal ureter interposition or nephrectomy are alternative treatments. As technology advances, the use of ureterorenoscopy (URS) increases and in parallel with this iatrogenic injuries that occur during the process have increased as well. These types of injuries are generally in form of simple perforations (2-6%), but from time to time ureter avulsions are also observed (0.3%). In this article, a case is presented where renal autotransplantation is made following development of ureter avulsion during ureterorenoscopy process carried out due to right ureteral calculi and treatment options are discussed in the light of literatures. WOS:000642343300016 PubMed: 33630296

Urinary tract injury during cesarean delivery is a rare but severe complication. Due to the high prevalence of cesarean delivery, this injury may pose a high burden of morbidity. We reviewed the cases of lower urinary tract injuries identified during cesarean delivery in a tertiary medical center and identified diagnosis and treatment methods, as well as short and long-term outcomes, to establish a protocol of care for such cases.We included women with urinary tract injury during cesarean delivery between 2004 and 2018. The cases were identified according to ICD-9 codes, as well as free text in the medical report and discharge letter. Data were collected retrospectively. Telephone interviews were conducted to obtain additional data regarding long-term outcomes.In14 years, a total of 17,794 cesarean deliveries were performed at our institution (17.5% of all deliveries), 14 cases of bladder injury, and 11 cases of ureteral injury were identified featuring an incidence of 0.08 and 0.06%, respectively. All bladder injuries were diagnosed and repaired intra-operatively. Six (55%) cases of ureteral injury were diagnosed in the post-operative period, and 3 of these patients required further surgery for definitive treatment. None of the patients suffered long-term adverse effects. Most bladder injuries occurred in women with previous cesarean delivery in the presence of abdominal adhesions. In contrast, most ureteral injuries occurred in women with emergency cesarean delivery during the second stage of labor, and were accompanied by an extension of the uterine incision. All women had normal kidney function in follow up and did not suffer from long term sequelae.Urinary tract injury is an uncommon complication of cesarean delivery. A high index of suspicion is recommended to avoid late diagnosis and complications. We propose a comprehensive protocol for the management of these injuries.

Ureteral injuries although rare can cause serious issues. The mechanism of injury is most commonly penetrating but in some rare cases blunt forces can contribute. It is important to diagnose ureteral injuries as soon as possible because they can have significant morbidity and mortality. Here we present two cases of isolated ureteral injury secondary to blunt force trauma. Both patients had the ureteral injury diagnosed by computed tomography (CT) scan and confirmed by a ureterogram with extravasation of contrast. Both patients also had peripelvic cyst, which could have been a contributing risk factor for injury. In both cases, the ureteral injury was repaired using a stent and both patients had no complications. We present these cases along with presentation, diagnostic work-up, and treatment.

Тrauma of the ureter often occurs during gynecological operations. Detection of the injury during the surgery is the most efficient for its correction. However, intraoperative identification of ureteral trauma, according to deferent authors’ opinion is in average 7–39 %. Ureter catheterization helps to early intraoperative identification of theinjury, and in a case of risk factors in patients is an effective measure to prevent ureter damage. During the gynecological operations typical localization of ureteral trauma is its distal third. The most effective method for the correction of ureter damage is the formation of ureteroneocystostomyin various modifications. The result of the treatment depends on the functional state of the injured ureter. Using the electroureterography during the correcting injury allows us to objectively determine the functional activity of the ureter and the boundaries of its destruction. However, in domestic and international literature there is no evaluation of its use in choosing method for correcting the ureter injury. The authors conclude that the further research is necessary to study the results of intraoperative electroureterography usage while choosing a method of treatment of the ureter injury, and scientific substantiation of the method.

Duplex ureter, an embryological developmental anomaly, can lead to intra-operative injuries, even by surgeons with a stronghold on normal ureteric anatomy. We describe the first case of an ectopic ureter transected during vaginal hysterectomy performed for pelvic organ proplase, due to its abnormally low implantation into the bladder, worsened by cystocoele. The injury was recognised, and the duplex ureter was diagnosed with cystoscopy and retrograde pyelography. A post-operative computed tomography urogram allowed us to map the exact course. In this case, there was injury to the ectopic, non-functional ureter, thus averting any further intervention. However, lower urinary tract injuries are serious complications with high morbidity, especially during delayed diagnosis. Knowledge of the ureter variants, meticulous tracing of the course, and use of post-operative cystoscopy could reduce these complications, particularly in face of increasing minimally invasive approaches.

A right hemicolectomy is among the most commonly performed operations for colon cancer, but modern high-quality, multination data addressing the morbidity and mortality rates are lacking.This study reports the morbidity and mortality rates for right-sided colon cancer and identifies predictors for unfavorable short-term outcome after right hemicolectomy.This was a snapshot observational prospective study.The study was conducted as a multicenter international study.The 2015 European Society of Coloproctology snapshot study was a prospective multicenter international series that included all patients undergoing elective or emergency right hemicolectomy or ileocecal resection over a 2-month period in early 2015. This is a subanalysis of the colon cancer cohort of patients.Predictors for anastomotic leak and 30-day postoperative morbidity and mortality were assessed using multivariable mixed-effect logistic regression models after variables selection with the Lasso method.Of the 2515 included patients, an anastomosis was performed in 97.2% (n = 2444), handsewn in 38.5% (n = 940) and stapled in 61.5% (n = 1504) cases. The overall anastomotic leak rate was 7.4% (180/2444), 30-day morbidity was 38.0% (n = 956), and mortality was 2.6% (n = 66). Patients with anastomotic leak had a significantly increased mortality rate (10.6% vs 1.6% no-leak patients; p0.001). At multivariable analysis the following variables were associated with anastomotic leak: longer duration of surgery (OR = 1.007 per min; p = 0.0037), open approach (OR = 1.9; p = 0.0037), and stapled anastomosis (OR = 1.5; p = 0.041).This is an observational study, and therefore selection bias could be present. For this reason, a multivariable logistic regression model was performed, trying to correct possible confounding factors.Anastomotic leak after oncologic right hemicolectomy is a frequent complication, and it is associated with increased mortality. The key contributing surgical factors for anastomotic leak were anastomotic technique, surgical approach, and duration of surgery. See Video Abstract at http://links.lww.com/DCR/B165. PREDICTORES DE FUGA ANASTOMóTICA, COMPLICACIONES POSTOPERATORIAS Y MORTALIDAD DESPUéS DE LA COLECTOMíA DERECHA POR CáNCER: RESULTADOS DE UNA AUDITORíA INTERNACIONAL DE CORTO PLAZO: La hemicolectomía derecha se encuentra entre las operaciones más frecuentemente realizadas para cáncer de colon, pero faltan datos modernos multinacionales de alta calidad, que aborden las tasas de morbilidad y mortalidad.Reportar la tasa de morbilidad y mortalidad para cáncer de colon del lado derecho, e identificar predictores de resultados desfavorables a corto plazo, después de la hemicolectomía derecha.Estudio prospectivo observacional de corto plazo.Estudio multicéntrico internacional.El estudio de corto plazo de la Sociedad Europea de Coloproctología de 2015, fue una serie prospectiva multicéntrica internacional, que incluyó a todos los pacientes sometidos a hemicolectomía derecha electiva, de emergencia o resección ileocecal, por un período de dos meses y a principios de 2015. Este es un subanálisis, cohorte de pacientes con cáncer de colon.Los predictores de fuga anastomótica, morbilidad y mortalidad postoperatorias a los 30 días, se evaluaron usando modelos de regresión logística de efectos multivariables mixtos, después de la selección de variables con el método Lasso.De los 2,515 pacientes incluidos, se realizó una anastomosis en el 97,2% (n = 2,444); sutura manual en 38.5% (n = 940) y por engrapadora en 61.5% (n = 1504) casos. La tasa global de fuga anastomótica fue del 7,4% (180/2,444), morbilidad a los 30 días fue del 38,0% (n = 956) y la mortalidad fue del 2,6% (n = 66). Los pacientes con fuga anastomótica tuvieron una tasa de mortalidad significativamente mayor (10,6% frente al 1,6% de pacientes sin fuga, p0,001). En el análisis multivariable, las siguientes variables se asociaron con la fuga anastomótica: mayor duración de la cirugía (OR 1.007 por minuto, p = 0.0037), abordaje abierto (OR 1.9, p = 0.0037) y anastomosis por engrapadora (OR 1.5, p = 0.041).Este es un estudio observacional y por lo tanto podría estar presente el sesgo de selección. Por esta razón, se realizó un modelo de regresión logística multivariable, tratando de corregir posibles factores de confusión.La fuga anastomótica después de la hemicolectomía derecha oncológica, es una complicación frecuente y asociada a mayor mortalidad. Los factores quirúrgicos clave que contribuyeron a la fuga anastomótica, fueron la técnica anastomótica, abordaje quirúrgico y duración de la cirugía. Consulte Video Resumen en http://links.lww.com/DCR/B165. (Traducción-Dr. Fidel Ruiz Healy).

Ureteral injury is common complication that need comprehensive understanding of ureteral injury management from minimal invasive intervention to ureteral reimplant in both early and late presentation. However, ureteral injury in duplex system rarely reported in literature. Here we are sharing our techniques and challenging in a patient who had a duplex ureteral injury with late presentation underwent robot assisted ureteral reimplantation.

Ureteral injuries reportedly occur in 2–5% of gunshot wounds to the abdomen, and are even rarer in abdominal stab wounds. Ureteral injuries are usually silent and produce no early signs or symptoms. An unrecognized or mismanaged ureteral injury can lead to significant morbidity and mortality. A 34-year-old woman was transferred to our emergency department from another hospital after removal of a knife on her abdomen. She was diagnosed with isolated ureter injury. An uretero-ureterostomy was performed after stenting of the ureteral catheter. The postoperative course was uneventful, and the patient was discharged on postoperative day 12. Keywords: Ureteral injuries, Stab wounds, Uretero-ureterostomy

A 75-year-old woman complained of anuria and a sense of discomfort with severe pelvic organ prolapse (POP). We planned tension-free vaginal mesh (TVM) surgery after curing mucosal defects and completing treatment for diabetes mellitus. Anuria and pyelonephritis relapsed repeatedly due to the failure of ring pessary therapy. Surgical treatment was required emergently. We performed a total laparoscopic hysterectomy and uterosacral ligament colpo-suspension (Shull’s method). Although the vaginal apex was supported to a good position, cystocele occurred six months after the initial surgery. A TVM procedure for recurrent cystocele was performed after curing the mucosal defects, and after the improvement of glycemic control. Transvaginal native tissue repair has the advantages of low risk of ureter injury, firm colpo-suspension, and no need for mesh usage. On the other hand, it is not good at treating cystocele. Transvaginal native tissue repair should prove to be a useful surgical option for apical support without mesh.

Background: Osteophytes are bony outgrowths commonly found on lumbar vertebrae. They rarely produce complications with the most common complication being nerve entrapment, but rarer complications including aorta or inferior vena cava rupture, superior mesenteric artery syndrome, compression of the iliopsoas muscle, and cerebrospinal fluid leaks have been described. Rare cases affecting the ureter resulting in ureteral colic or extravasation of urine have been described. Case Presentation: We describe a case in which a lumbar osteophyte bridging the L4 and L5 disks was encircling the ureter and minor trauma caused a ureteral injury, resulting in urine extravasation into the L4 and L5 disks space and the retroperitoneum. Owing to the comorbidities of this patient, this case was treated conservatively with stenting and the patient has suffered no further complications. Conclusion: This is a rare complication of a lumbar osteophyte but should be considered as a potential cause of ureter injury. Treatment should be individualized by patient preference and comorbidities, as some patients would elect to pursue more aggressive therapy whereas others would incline for conservative measures.

The ureters are rarely exposed to trauma. Ureteral injuries are generally in the form of iatrogenic, blunt injuries, and rarely penetrating injuries. Iatrogenic injuries often occur during surgical procedures. They do not present with specific findings and symptoms, therefore, they have late-onset symptoms. Imaging modalities of choice are usually intravenous pyelography and computed tomography. Treatment is tailored to the location of the trauma.

The presenting symptom to a gynecologist for postoperative vaginal discharge, which may or may not be related to the gynecologic diagnosis. The postoperative delayed ureter injury is an unusual association with deep endometriosis surgery. Thermal necrosis can delay the ureter injury. The principle of diagnostic bias and educate gynecologists on the topic of delayed ureter injury state that delayed ureter injury due to thermal necrosis. A 45-year-old woman with menorrhagia and mild dysmenorrhea. The diagnosis was adenomyosis, a right endometrioma and deep infiltrating endometriosis (DIE) affecting the Pouch of Douglas. The management was ureter stent insertion lead to postoperative delayed ureter injury. The occurrence could be guidance to surgeons about the duration of postoperative detection for delayed ureter injury. Gynecologists should consider the presenting symptom of vaginal discharge is formulating their differential diagnosis.

Introducción: La sustitución ureteral por un asa de íleon desfuncionalizada fue descrita hace más de 2 siglos y continúa siendo una alternativa terapéutica en la actualidad. Esta serie describe la técnica de sustitución ureteral bilateral con íleon. Objetivo: Presentar 4 casos de sustitución ureteral ileal bilateral realizados en nuestro centro, indicaciones de la técnica quirúrgica, complicaciones y revisión de la literatura. Material y Método: Presentamos 4 casos de lesión ureteral bilateral extensa, de etiologías diferentes, cuyo tratamiento con intención curativa fue la sustitución de la lesión ureteral por un segmento intestinal isoperis-táltico. Resultados: La técnica quirúrgica empleada fue estándar en todos los casos. No hubo complicaciones intraoperatorias, y sólo una paciente presentó descompensación metabólica por acidosis hiperclorémica. En ningún paciente se ha demostrado pérdida en la función renal. Conclusión: El segmento intestinal de íleon desfuncionalizado es una alternativa terapéutica eficaz, segura y reproducible, para el reemplazo de importantes lesiones ureterales bilaterales, independiente de la causa original.

The iatrogenic ureter injuries are rare complications and may have serious consequences. The treatment options depend on situations. Pelvic surgeons, keep in mind that this kinds of complications, is very important for diagnosis and treatment, during the surgery. This report presents a case of a patient with iatrogenic left ureteral injury during hysterectomy. The patient visited emergency department of our hospital with the chief complaints of left lomber pain on the 17th day of hysterectomy. After evaluation in emergency clinic, the patient had an endoscopic treatment for iatrogenic ureter injury. The patient is still in follow-up period. We also review the literature and discuss diagnose, treatment, prognosis of iatrogenic ureter injuries. The treatment options are still developing by technology. © 2012 All rights reserved

The existing treatment options for pediatric urolithiasis are endoscopic methods. Extracorporeal shockwave lithotripsy (SWL) is the first-line option for most of the kidney stones smaller than 1 cm in diameter. For larger stones or refractory cases, minimally invasive surgical methods are preferred. Percutaneous nephrolithotomy (PCNL) is a well-established treatment modality for most patients. This technique has shown evolution also in children so that miniaturized or tubeless methods could now be performed. Recent series show that flexible ureteroscopy is also becoming an important treatment option in the pediatric urology armamentarium for treating the calyceal and lower pole stones. Open surgery has a very limited role and it may be of use when there is a need to do an adjuvant reconstructive surgery. With the increasing experience, laparoscopic surgery is becoming an alternative option that may have potential to replace the open techniques.

Background: Hysterectomy is one of the most common surgical procedures performed by the gynaecologist. It can be performed by vaginal and abdominal route. Gynaecologic surgeons worldwide continue to use the abdominal approach for a large majority of hysterectomies that could be performed vaginally despite well-documented evidence that vaginal hysterectomy has better outcome. Aim of our study is to compare vaginal route versus abdominal route of hysterectomy in terms of intra operative and post operative complications. Methods: A retrospective study was done in 229 women who had undergone hysterectomy (176 abdominal hysterectomies and 53 vaginal hysterectomies) from January 2010 to July 2012. Information on the indications, operative procedures, and complications were extracted and analysed. Results: The mean duration of surgery in VH group was 79.6 min and that of TAH group was 99.2 min. The mean blood loss was also more in case of TAH group than that of VH group (215ml vs. 167ml). Bladder injury occurred in 1 case in VH (1.9%) and in 4 cases in TAH (2.3%). Ureter injury occurred in 1(0.6%) case in TAH group. Wound infection developed in 10 cases of TAH group whereas only one case in VH group developed vault infection. Conclusions: Vaginal hysterectomy is associated with quicker recovery, early mobilization, shorter hospitalization, less operative and post operative morbidity when compared to abdominal hysterectomy.

Purpose: Alloplastic mesh implantation is frequently used in reconstructive pelvic floor surgery, although there are only few study results on the safety and cure rates. In a multiinstitutional observation study we analyzed the safety of a vaginal implantation technique with transobturatoric and sacrospinous fixation of alloplastic meshes in the anterior and central compartment of the pelvic floor. Material and Methods: Nine urogynecologic centers used a questionnaire to collect data from the surgeries retrospectively. Every patient with a transobturatoric monofilament polypropylene mesh implantation was included into the study; there were no exclusion criteria. Results: A transobturatoric mesh was implanted in 183 patients with cystoceles, vaginal vault prolapse or uterine descensus. Intraoperative complications were observed in 7.1 % of patients (6 x blood loss > 500 ml, 4 bladder and 3 rectum lesions, a ureter injury occurred during hysterectomy). Only one bladder lesion occurred during the transobturatoric mesh suspension. During the early postoperative period as an inpatient, 14.3% of patients showed some irregularities (16 x residual urine > 100 ml, 3 infections with fever, 6 postoperative hemorrhages, 10 x moderate or severe pain). A follow-up examination after 3 to 6 months was performed in 128 patients and no complications were found in 78.9%. A recurrence was observed in 4%, residual urine > 100 ml in 2.4%, pain in 3.2% and pain during intercourse in 2.4%. A mesh erosion was observed in 8% of patients treated with the recommended surgery technique. Although the method was not intended as a surgical procedure for incontinence, incontinence disappeared in 76.4% of the initially urge or stress incontinent patients. De novo incontinence was observed in 2.4%. Conclusion: Transobturatoric fixation with and without additional sacrospinous fixation of an alloplastic mesh is a safe and effective method for the treatment of pelvic floor defects.

Injury to the ureter is the most common urologic complication of pelvic surgery, with an incidence that ranges from 1% to 10%. Most cases of ureteral injuries are related to gynecologic procedures. The ureter is particularly vulnerable to detachment or ligation during hysterectomy because of its position from the lateral edge of the cervix. We report a case series of female patients who underwent the ureteral rendezvous procedure for ureteral detachment.Between January 2009 and April 2013, 18 ureteral rendezvous procedures were performed for patients with complete detachment. We assessed the operative and clinical outcomes of these patients over a mean follow-up duration of 26.5 months and describe the three most representative cases.The endoscopic rendezvous technique was performed in all cases to manage ureteral detachment. CT urography at discharge and 6 and 12 months after discharge confirmed the restoration of ureteral integrity without any leakage in 66% (12/18) patients, indicated ureteral stenosis in 22% (4/18) patients, and indicated ureteral leakage in 12% (2/18) patients. The overall long-term success rate for all 18 patients was 78% (14/18) at a mean follow-up of 26.5 months.The endoscopic rendezvous procedure reduces the need for invasive open surgical repair and represents the optimal initial option in patients with iatrogenic ureteral lesions before invasive procedures with higher morbidity are attempted.

Ureter injury is typically a rare complication, albeit with serious sequelae, of a hysterectomy procedure, especially after laparoscopic hysterectomy. Herein we report on a successful laparoscopic reanastomosis of the ureter conducted at the ureterovesical junction.

PURPOSE We determined whether laparoscopic radical cystectomy (LRC) was useful for the patients with bladder cancer. MATERIALS AND METHODS We investigated the surgical outcome of LRC in the initial 30 patients with bladder cancer. RESULTS Mean patients age was 68 (54-81) years old. Twenty six male and 4 female were enrolled. Lymphnode dissection was variably performed under aeroperitoneum. Twenty six patients were undergone ileal conduit and 4 patients were undergone ileal neobladder as urinary diversion. The urinary diversion of all cases was undergone extra-corporeally. Seventeen patients were received platinum based neo and adjivant-chemotherapy. Mean surgical time was 684 (398-950) min, and mean aeroperitoneum time was 418 (235-660) min. Intraoperative major complications were ureter injury and blood loss. Mean blood loss was 1,063 (150-2,730) ml intraoperatively. Ileus and acute pyeronephritis were observed in the 3 patients postoperatively. Seven patients relapsed and 2 patients died with bladder cancer in 14.9 months of median follow-up period (0.7-35.9) after the surgery. Progression free survival rate and overall survival rate at a year after surgery were 75.2% and 100%, respectively. CONCLUSIONS The surgical therapy with LRC was well tolerated and successful in the patients with bladder cancer.

Reproductive tract surgery carries a risk of injury to the bladder, ureter, and gastrointestinal (GI) tract. This is due to several factors including close surgical proximity of these organs, disease processes that can distort anatomy, delayed mechanical and energy effects, and the inability to directly visualize organ surfaces. The purpose of this article is to review strategies to prevent, recognize, and repair injury to the GI and urinary tract during gynecologic surgery.

Background: Hysterectomy is the most frequently performed elective major operation in gynaecology by vaginal and abdominal route. Gynaecologic surgeons worldwide said that two are not competitive procedures but each one has its own place in the operative armamentarium. Present study is done to comparative risks of complications in abdominal route versus vaginal route of hysterectomy in intra operative and post-operative periods. Methods: It’s a retrospective study was done from Dec 2013 - Dec 2014 for a period of one year in 82 women who had undergone hysterectomy, divided as group A with abdominal hysterectomies (44 cases) and group B with vaginal hysterectomies (38). Information on the indications, operative procedures, and complications were noted and analyzed. Results: Intra-operative blood loss, mean operating time was more in group A than in group B. The mean duration of surgery in group B was 76 ± 12 min and that of group B was 101 ± 14 min. The mean blood loss was also more in case of group A than that of group B (219 ml vs. 172 ml). Bladder injury occurred in 1 case in group B (3%) and in 3 cases in group B (7%). Ureter injury occurred in 1 (2%) case in group A. Postoperative fever (20% & 8%), UTI (13% & 11%) and wound infection (10%, 0%). Only one patient underwent relaparotomy for internal bleeding via abdominal route was more common in group A as compared to group B. Only one patient underwent re-laparotomy for internal bleeding via abdominal route. Conclusions: Study results conclude that patients requiring hysterectomy for benign non prolapse cases be offered the option of vaginal route which is quicker recovery, early mobilization, shorter hospitalization, less operative and post-operative morbidity, more economical and effective.

To determine the incidence, risk factors and morbidity of unintended operative injury to the bladder or ureter during hysterectomy, a retrospective case–control study of women with these injuries from 1 January 1993 to 1 January 1998 was performed. The incidence of bladder and ureter injury, respectively, was 0.58% and 0.35% for abdominal hysterectomy, 1.86% and 0% for vaginal hysterectomy, and 5.13% and 1.71% for hysterectomies performed for obstetric indications. Women with injury during abdominal hysterectomy were found to have greater blood loss, longer operative times, longer postoperative stays, more febrile morbidity, and more frequent transfusions. Similar trends were seen for other hysterectomy types. The incidence of operative bladder or ureter injury is relatively low. However, even when recognized, these individuals experience greater operative and postoperative morbidity. This highlights the importance of surgical technique directed toward minimization of these injuries, and careful intra- and postoperative surveillance aimed at early detection.

Objective We wanted to present the results of percutaneous management of ureteral injuries that were diagnosed late after cesarean sections (CS). Materials and Methods Twenty-two cases with 24 ureteral injuries that were diagnosed late after CS underwent percutaneous nephrostomy (PN), antegrade double J (DJ) catheter placement and balloon dilatation or a combination of these. The time for making the diagnosis was 21 ± 50.1 days. The injury site was the distal ureter in all cases (the left ureter: 13, the right ureter: 7 and bilateral: 2). Fifteen complete ureteral obstructions were detected in 13 cases. Ureteral leakage due to partial (n = 4) or complete (n = 3) rupture was noted in seven cases. Two cases had ureterovaginal fistula. All the cases were initially confirmed with antegrade pyelography and afterwards they underwent percutaneous nephrostomy. Balloon dilatation was needed in three cases. Antegrade DJ stents were placed in 10 cases, including the three cases with balloon dilatation. Repetititon of percutaneous nephrostomy with balloon dilatation and DJ stent placement was needed in one case with complete obstruction. All the cases were followed-up with US in their first week and then monthly thereafter for up to two years. Results Eighteen ureters (75%) were managed by percutaneous procedures alone. A total of six ureter injuries had to undergo surgery (25%). Conclusion Percutaneous management is a good alternative for the treatment of post-CS ureteral injuries that are diagnosed late after CS. Percutaneous management is at least preparatory for a quarter of the cases where surgery is unavoidable.

Ureter injury is more common with abdominal hysterectomy than vaginal hysterectomy. Complications during laparoscopy-assisted vaginal hysterectomy cases have not been thoroughly studied. Two cases are presented that highlight urologie misadventures, specifically, ureteral injury, with the endoscopic linear stapler during laparoscopy-assisted vaginal hysterectomy.