204 results on '"Urinary tract injury"'
Search Results
2. Urinary tract injuries during surgery for placenta accreta spectrum disorders.
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Giuseppe, Calì, Salvatore, Polito, Federica, Calò, Francesco, Labate, Francesco, D'Antonio, Alessandro, Lucidi, and Gloria, Calagna
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PLACENTA accreta , *URINARY organs , *CESAREAN section , *SURGICAL complications , *SURGICAL diagnosis , *PRENATAL diagnosis - Abstract
The main purpose of this study was to report the incidence of lower urinary tract injuries (UTI) during cesarean section (CS) hysterectomy in cases of Placenta Accreta Spectrum (PAS) disorders. Study design Retrospective analysis including all women with a prenatal diagnosis of PAS between January 2010 and December 2020. A dedicated multidisciplinary team was involved to define a tailored management for each patient. All relevant demographic parameters, risk factors, degree of placental adhesion, type of surgery, complications and operative outcomes were reported. One hundred and fifty-six singleton gestations with a prenatal diagnosis PAS were included in the analysis. 32.7% of cases were classified as PAS 1 (grade 1-3a FIGO classification), 20.5% as PAS 2 (grade 3b FIGO classification) and 46.8% as PAS 3 (grade 3c FIGO classification). A CS hysterectomy was performed in all cases. Surgical complication occurred in seventeen cases (0% in PAS 1, 12.5% in PAS 2 cases and in 17.8% in PAS 3). The incidence of UTI in our series was 7.6% in all women with PAS, including 8 cases of bladder and 12 of ureteral lesion, and 13.7 % in those with PAS 3 only. Despite advances in prenatal diagnosis and management, surgical complications, mainly those involving the urinary system, still occur in a significant proportion of women undergoing surgery for PAS. The findings from this study highlight the need for a multidisciplinary management of women with PAS in centers with high expertise in prenatal diagnosis and surgical management of these conditions. [ABSTRACT FROM AUTHOR]
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- 2023
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3. Iatrogenic bladder and ureteral injuries following gynecological and obstetric surgery.
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Jensen, Ann-Sophie and Rudnicki, Martin
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BLADDER , *URINARY organs , *IATROGENIC diseases , *WOUNDS & injuries , *URINARY catheterization , *GYNECOLOGIC surgery , *REOPERATION - Abstract
Key message: Ureteral injuries are often associated with complications and risk of fistula especially in case of malignancy. Length of catheterization should be reconsidered according to the injury. Purpose: Iatrogenic urinary tract injuries are potential complications of gynecologic and obstetric surgery. Our aim was to describe suture type and size, length of urethral catheterization, length of hospitalization, reoperation rate, follow-up, and impact on quality of life following iatrogenic bladder and ureteral injury. Methods: In total, 81 women met inclusion criteria. Bladder injuries included 55 women, ureteral injuries in 23 women, and three women had bladder and ureteral injuries. Results: Most bladder injuries were managed by a two-layer suture followed by transurethral catheterization for 11.4 days (95% CI 9.1–13.6). The most frequent suture type was 3.0 Vicryl in all subgroups. In total, 30.4% of ureteral injuries were managed by neoimplantation followed by ureteral stenting for 38.0 days (95% CI 22.0–54.0) and transurethral catheterization for 16.9 days (95% CI 5.3–28.4), or by ureteral stenting for 46.7 days (95% CI 31.5–61.2) and transurethral catheterization for 6.25 days (95% CI 1.0–13.5). Altogether, 25 (30.9%) women underwent a reoperation mostly due to ureteral injury (68%). In total six women developed a fistula, of whom five had malignant surgery. Multiple linear regression showed a statistically significant increased median length of urethral catheterization when the duration of surgery increased. Conclusions: Our study demonstrates a high reoperation rate, and a high fistula rate in case of malignancy. Length of catheterization was high even in case of benign surgery, however, only one woman developed a fistula in the benign group, suggesting a reduction in catheterization length. [ABSTRACT FROM AUTHOR]
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- 2023
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4. Detection rate with routine postoperative renal ultrasound to identify urinary tract injury after gynecological surgery.
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Binder, Simon, Boosz, Alexander, Kolioulis, Ioannis, Baev, Evgeni, Müller, Nadine, Krämer, Janine, and Müller, Andreas
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URETERS , *HYSTERECTOMY , *RETROSPECTIVE studies , *URINARY organs , *GYNECOLOGIC surgery , *OVARIECTOMY - Abstract
Purpose: The aim of this study was to establish the rate at which routine postoperative renal ultrasonography is able to detect urinary tract injury following gynecological surgery.Methods: A retrospective analysis was carried out for the study period 2015-2019 of all patients who had undergone subtotal or total hysterectomy, or radical hysterectomy or salpingectomy, salpingo-oophorectomy, or oophorectomy, and subsequently had a urinary tract injury.Results: In a total of 2068 patients, 25 urinary tract injuries occurred (1.21%), including 21 urinary bladder lesions (1.02%) and four ureteral injuries (0.19%). The incidence of urinary tract injuries was 3% in oncologic procedures and 0.86% in procedures for benign disease. Nineteen injuries (76%) were diagnosed intraoperatively, and six injuries (24%) were clinically diagnosed after surgery. All of the patients had uneventful postoperative renal ultrasound examinations.Conclusion: Routine postoperative renal ultrasonography was not capable of diagnosing urinary tract injuries after gynecologic surgery. Routine postoperative renal ultrasound examinations should, therefore, not be performed after gynecologic operations. [ABSTRACT FROM AUTHOR]- Published
- 2022
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5. Urinary tract injuries during cesarean delivery: long-term outcome and management.
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Safrai, Myriam, Stern, Shira, Gofrit, Ofer N., Hidas, Guy, and Kabiri, Doron
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CESAREAN section , *URINARY organs , *SECOND stage of labor (Obstetrics) , *UTERINE rupture , *TISSUE adhesions , *KIDNEY physiology - Abstract
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. [ABSTRACT FROM AUTHOR]
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- 2022
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6. Out-of-Hospital Cardiac Arrest With Bilateral Urinary Tract Injury Resulting From Cardiopulmonary Resuscitation: A Case Report.
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Tada S, Kikuta S, Matsuyama S, and Ishihara S
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A man in his 70s suffered cardiac arrest, and his family initiated cardiopulmonary resuscitation after placing an emergency call. The initial waveform of the automated external defibrillator performed by emergency medical technicians revealed ventricular fibrillation. The patient received cardiovascular life support, including direct current countershock, and was transported to the hospital. Upon arrival, he underwent extracorporeal cardiopulmonary resuscitation using an automated chest compression device. Additionally, an intra-aortic balloon pumping was introduced after coronary angiography and percutaneous coronary intervention. Plain computed tomography images revealed leakage of the contrast medium used during coronary angiography in the bilateral renal pelvis and perirenal area as well as bladder retention. Furthermore, a urine test revealed gross hematuria. There were no findings of prostatic hypertrophy or urinary tract disease. Based on the patient's clinical course, injury caused by chest compression was the most likely etiology of urinary tract injury, which must be considered in such patients. The patient was discharged with cerebral performance category 1, without any complication except urinary tract., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tada et al.)
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- 2024
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7. Vaginal Fistula Repairs
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Thum, Lauren Wood, Vinson, Nika M., Medendorp, Andrew R., Scott, Victoria, Raz, Shlomo, and Firoozi, Farzeen, editor
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- 2020
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8. Exploring the feasibility of indocyanine green fluorescence for intraoperative ureteral visualisation in robotic transvaginal natural orifice transluminal endoscopy surgery during endometriosis resection.
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Delgadillo Chabolla LE, Alpuing Radilla LA, Koythong T, Sunkara S, Mendez Y, Wang Q, and Guan X
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- Humans, Female, Adult, Retrospective Studies, Middle Aged, Fluorescence, Vagina surgery, Operative Time, Hysterectomy methods, Indocyanine Green, Endometriosis surgery, Endometriosis diagnostic imaging, Robotic Surgical Procedures methods, Feasibility Studies, Natural Orifice Endoscopic Surgery methods, Ureter surgery
- Abstract
Background: To assess the feasibility of use of indocyanine green (ICG) in identifying and minimising urinary tract injury during surgical resection of endometriosis through robotic transvaginal natural orifice transluminal endoscopy surgery (RvNOTES)., Methods: We conducted a retrospective case series in two academic tertiary care hospitals. We examined 53 patients who underwent RvNOTES hysterectomy with planned endometriosis resection., Results: The study involved 53 patients undergoing RvNOTES with ICG fluorescence for endometriosis resection. Mean patient age was 37.98 ± 6.65 years. Operative time averaged 181.32 ± 53.94 min, with estimated blood loss at 45.57 ± 33.62 mL. Postoperative stay averaged 0.23 ± 0.47 days. No ICG-related complications occurred., Conclusion: No complications occurred with ICG fluorescence in RvNOTES. It appears to be a safe option for ureteral localisation and preservation. ICG fluorescence is widely used in diverse medical specialities for identifying ureters during complex surgeries. Larger studies are needed to firmly establish its advantages in intraoperative ureteral visualisation during RvNOTES for deep infiltrative endometriosis., (© 2024 John Wiley & Sons Ltd.)
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- 2024
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9. Complications of Robotic Surgery: Prevention and Management
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Lönnerfors, Celine, Persson, Jan, El-Ghobashy, Alaa, editor, Ind, Thomas, editor, Persson, Jan, editor, and Magrina, Javier F., editor
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- 2018
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10. Synthetic Midurethral Slings: Urinary Tract Sequelae
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Brown, Elizabeth Timbrook, Cohn, Joshua A., Kaufman, Melissa R., Reynolds, William Stuart, Dmochowski, Roger R., Klein, Eric A., Series editor, and Goldman, Howard B., editor
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- 2017
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11. Management and Complications
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Dorairajan, Gowri and Dorairajan, Gowri
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- 2017
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12. Imaging of Penetrating Urologic Trauma
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Schnüriger, Beat, Green, Donald J., Velmahos, George C., editor, Degiannis, Elias, editor, and Doll, Dietrich, editor
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- 2017
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13. Risk of Urinary Tract Infection Symptoms after Posthysterectomy Cystoscopy with 50% Dextrose as Compared with Saline Cystoscopy with Indigo Carmine.
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Misal, Meenal, Dizon, A. Mitch, Louie, Michelle, Carey, Erin T., Wright, Kelly N., Greene, Naomi H., and Siedhoff, Matthew T.
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Study Objective: Compare odds of postoperative urinary symptoms in women who had cystoscopy after benign laparoscopic hysterectomy with 50% dextrose and with normal saline solution with intravenous indigo carmine.Design: Retrospective cohort study.Setting: Two tertiary care centers.Patients: All women who underwent benign laparoscopic hysterectomy and intraoperative cystoscopy carried out by a single surgeon.Interventions: We compared postoperative urinary symptoms in patients who received 50% dextrose cystoscopy fluid (January 2016-June 2017) with those who received saline cystoscopy with intravenous indigo carmine (November 2013-April 2014).Measurements and Main Results: A total of 96 patients had cystoscopy with 50% dextrose and 104 with normal saline with intravenous indigo carmine. Differences in baseline characteristics of the two groups of participants mainly reflected institutional population diversity: age (45.2 vs 41.9, p = .01), body mass index (26.9 vs 33.4, p <.01), race, current smoking status (1% vs 7.8%, p = .04), diabetes (2.1% vs 11.5%, p = .01), history of abdominal surgery (53.1% vs 74%, p <.01), hysterectomy type, receipt of intraoperative antibiotics (92.7% vs 100%, p <.01), recatheterization (10.4% vs 0%, p <.01), and removal of catheter on postoperative day 0 (66.7% vs 12.5%, p <.01). Urinary symptoms were similar for 50% dextrose and saline (12.5% vs 7.7%, p = .19). After adjusting for age, body mass index, race, diabetes, and day of catheter removal, there remained no significant differences in urinary symptoms between the groups (odds ratio 3.19 [95% confidence interval, 0.82-12.35], p = .09). One immediate bladder injury was detected in the saline group and 1 delayed lower urinary tract injury in the 50% dextrose group.Conclusion: Overall, most women experienced no urinary symptoms after benign laparoscopic hysterectomy. There were no significant differences in postoperative urinary symptoms or empiric treatment of urinary tract infection after the use of 50% dextrose cystoscopy fluid as compared with normal saline. The previous finding of increased odds of urinary tract infection after dextrose cystoscopy may be due to use in a high-risk population. [ABSTRACT FROM AUTHOR]- Published
- 2021
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14. Urological complications in obstetrics
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Dina F . Absalyamova, Ruslan I . Safiullin, Yulia N. Fatkullina, Ksenia N. Yashchuk, Il’nur I. Musin, Marat F. Urmantsev, and Edvard A. Berg
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medicine.medical_specialty ,business.industry ,Obstetrics ,Urinary system ,Obstetrics and Gynecology ,medicine.disease ,Urethra ,medicine.anatomical_structure ,Hematoma ,Ureter ,Obstetrics and gynaecology ,medicine ,Urinary tract injury ,Stage (cooking) ,business ,Body mass index - Abstract
Urinary tract injury is a rare but severe complication during abdominal delivery. Over the past quarter of the last century, the frequency of abdominal delivery in Russia has more than tripled due to the increase in the number of pregnant women at high risk for the development of maternal and perinatal complications. Intraoperative diagnosis of urinary tract injuries allows timely treatment with better postoperative outcomes. Given the high percentage of caesarean sections in many countries, the risk of the above complications remains high. Risk factors for urinary tract injury during cesarean section are an increase in womens average age and body mass index, high parity, the presence of adhesions, prior cesarean section, emergency cesarean section, and cesarean section in the second stage of labor. This article discusses several clinical cases on the development of urological complications in obstetrics and gynecology. Due to modern progress in the field of operative obstetrics, vesicouterine fistulas caused by obstetric causes may not occur as often as in the last century. Nevertheless, even despite this, one should not forget about elementary preventive measures in operative delivery, especially in such obstetric situations as placental ingrowth, bleeding, hematoma, and parametria.
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- 2021
15. Urinary Tract Injury During Gynecologic Surgery
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Christine A. Heisler and Ushma J. Patel
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Pelvic organ ,medicine.medical_specialty ,business.industry ,Pelvic anatomy ,Urinary system ,Urinary tract injury ,medicine ,Obstetrics and Gynecology ,In patient ,business ,Postoperative management ,Surgery - Abstract
Lower urinary tract (LUT) injuries may occur during gynecologic surgery due to the close proximity of pelvic organs and vary by procedure, surgical indication, and route. Prevention of LUT injury should be a primary goal of gynecologic surgery. LUT injuries are more common in patients with aberrant anatomy, during difficult procedures, and with surgeons with less experience. Immediate recognition and management of LUT injuries is optimal, although delayed postoperative diagnoses may be unavoidable. Surgical management is based on the size and location of injury and should be performed by an experienced surgeon with thorough knowledge of pelvic anatomy, surgical technique, and postoperative management.
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- 2021
16. Gynecologic Surgery
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Johnson, Bruce E. and Cohn, Steven L., editor
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- 2011
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17. Management of Urinary Tract Injuries
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Ghoniem, Gamal M., Hairston, John C., Davila, G. Willy, editor, Ghoniem, Gamal M., editor, and Wexner, Steven D., editor
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- 2009
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18. Urinary Tract Complications
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Ogah, Joseph A. and O’Donovan, Peter, editor
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- 2008
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19. Inadvertent injury during oocyte retrieval
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Khaldoun Sharif
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medicine.anatomical_structure ,business.industry ,Anesthesia ,Urinary tract injury ,Medicine ,Vertebral injury ,Nerve injury ,medicine.symptom ,business ,Oocyte - Published
- 2021
20. Management of Urinary Tract Injuries
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Ghoniem, Gamal M., Hairston, John C., Davila, G. Willy, editor, Ghoniem, Gamal M., editor, and Wexner, Steven D., editor
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- 2006
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21. Iatrogenic Urinary Tract Injury in Major Obstetrics and Gynaecological Surgeries
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Jehan Ara
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Iatrogenic injury ,Urinary tract injury ,Gynaecological surgeries ,Obstetric surgeries ,Medicine - Abstract
To determine the prevalence and types of iatrogenic urinary tract injuries during obstetrics and gynaecological procedures and to find out the possible risk factors. Methods: In this cross sectional study all patients undergoing major obstetrics and gynaecological surgeries were included. Variables included the personal data, age of the patient at time of surgery, Indication , type of surgery , location and type of injury and possible risk factors. Surgical approach and cause of injury was determined. Data regarding risk factors was collected on specified proforma. Iatrogenic urinary tract injury was defined as any inadvertent injury to the urinary tract for which additional intervention and observation was required. Major surgery was any surgery with duration more than 30 minutes including opening of peritoneal cavity. Results: Records of 1800 patients was studied. Out of 1900 patients 8(0.44 %) suffered from iatrogenic urinary tract injuries. Median age of patients was 33 years. The procedure in which most urinary tract injuries occurred was peripartum hysterectomy, second most common procedure was total abdominal hysterectomy. Most common injury was injury to urinary bladder. It was injured in 5 (0.27 %) cases.Ureters were damaged in 2 (0.11%) patients. Urethra was damaged during.1( 0.05%) procedure. The main risk factor was previous surgery with resultant adhesions present in 75% of patients having iatrogenic urinary tract injuries. Seven cases of injury were diagnosed at the time of operation and successfully repaired. 0ne case was diagnosed late and developed ureterovaginal fistula. Conclusion: Iatrogenic urinary tract injury is uncommon but carries serious morbidity. Adhesions due to previous surgery were an important risk factor
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- 2017
22. IATROGENIC URINARY TRACT INJURY IN OBSTETRIC AND GYNECOLOGICAL PROCEDURES: FIVE-YEAR- EXPERIENCE FROM TWO UNIVERSITY HOSPITALS
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Ali G. Ayad, Hany M. Abd El-Aal, Ahmed Gamal El-Din Abd El-Raouf, and Abd Allah M. El-Mogy
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,business.industry ,Genitourinary system ,Urinary system ,Fistula ,General surgery ,030232 urology & nephrology ,Retrospective cohort study ,medicine.disease ,Urogynecology ,03 medical and health sciences ,0302 clinical medicine ,Obstetrics and gynaecology ,Urinary tract injury ,Medicine ,Gynecological procedures ,business - Abstract
Background: Owing to improvements in gynecological and obstetric techniques that help to prevent urinary tract injury and immediate recognition and repair of any injury occur, long-term complications are less frequent nowadays. Aim of the Work: To evaluate the role and importance of the presence of a urogynecology team in management of Obstetrics and gynecology cases with high risk of urological injuries for preoperative assessment, intra operative management and post operatively for follow up of cases repaired and cases need late management like cases presented with urinary tract fistulae. Patients and Methods: This retrospective study included all patients with genitourinary injuries following obstetric and gynecologic procedures that were treated at the Department of Urology and department of obstetrics and gynecology, Al-Hussein and Sayed Galal University Hospitals during the past 5 years. All cases with urological injuries were managed by urogynecological team of urology department of Al-Azhar Cairo University. Results: In our study we detected 97 cases. We found 35 patients (36.1 %) were complicated in gynecological procedures while 62 patients (63.9%) were complicated in obstetric procedures, As regard our study three types of injuries were detected ureteric injuries (8.2%), bladder injuries (27.8%) and fistula formation (63.9%). Conclusion: Complicated gynecological and obstetric procedures with high risk of urological injuries should be managed in collaboration between obstetric ,gynecological and urogynecological teams for: preoperative assessment or intervention like; endoscopic stent fixation in cases with risk of injury, early detection of any urological injuries in all gynecological and obstetric procedures, early intervention and management of all types of urological injuries and follow up all managed patients and assessment and preparation of all cases need late repair.
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- 2021
23. The urological complications of vaginal birth after cesarean (VBAC) – a literature review
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Yassin Rhazi, Daniel Radavoi, Roxana Georgiana Bors, Ovidiu Nicolae Penes, and Valentin Nicolae Varlas
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medicine.medical_specialty ,urological complications ,Vaginal birth ,Review ,Bladder rupture ,Uterine Rupture ,Pregnancy ,Risk Factors ,Urinary tract injury ,medicine ,Humans ,Risks and benefits ,ureteral lesion ,Retrospective Studies ,Obstetrics ,business.industry ,Incidence (epidemiology) ,Incidence ,General Medicine ,medicine.disease ,VBAC ,Vaginal Birth after Cesarean ,Uterine rupture ,Female ,bladder rupture ,business - Abstract
The appearance of urological complications is a major problem in obstetrics and gynecologic surgery; the bladder is the most common damaged organ. Due to a continuous increase in the rate of cesareans, the incidence of urologic complications will be potentially higher. We reviewed the most important risk factors for urinary tract injury and analyzed the strategies necessary to avoid these situations during vaginal birth after cesarean (VBAC). The risks and benefits of VBAC should be balanced before deciding the mode of delivery.
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- 2021
24. Iatrogenic Urinary Tract Injury in Major Obstetrics and Gynaecological Surgeries.
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Ara, Jehan, Alam, Muhammad, and Iftikhar, Taqdees
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IATROGENIC diseases , *URINARY tract infections , *OBSTETRICS , *CROSS-sectional method , *GYNECOLOGIC surgery , *PERITONEUM - Abstract
Background: To determine the prevalence and types of iatrogenic urinary tract injuries during obstetrics and gynaecological procedures and to find out the possible risk factors. Methods: In this cross sectional study all patients undergoing major obstetrics and gynaecological surgeries were included. Variables included the personal data, age of the patient at time of surgery, Indication, type of surgery, location and type of injury and possible risk factors. Surgical approach and cause of injury was determined. Data regarding risk factors was collected on specified proforma. Iatrogenic urinary tract injury was defined as any inadvertent injury to the urinary tract for which additional intervention and observation was required. Major surgery was any surgery with duration more than 30 minutes including opening of peritoneal cavity. Results: Records of 1800 patients was studied. Out of 1900 patients 8(0.44 %) suffered from iatrogenic urinary tract injuries. Median age of patients was 33 years. The procedure in which most urinary tract injuries occurred was peripartum hysterectomy, second most common procedure was total abdominal hysterectomy. Most common injury was injury to urinary bladder. It was injured in 5 (0.27 %) cases. Ureters were damaged in 2 (0.11%) patients. Urethra was damaged during.1(0.05%) procedure. The main risk factor was previous surgery with resultant adhesions present in 75% of patients having iatrogenic urinary tract injuries. Seven cases of injury were diagnosed at the time of operation and successfully repaired. 0ne case was diagnosed late and developed ureterovaginal fistula. Conclusion: Iatrogenic urinary tract injury is uncommon but carries serious morbidity. Adhesions due to previous surgery were an important risk factor. [ABSTRACT FROM AUTHOR]
- Published
- 2017
25. Urological Injuries in Obstetrics and Gynaecological Surgery
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M. Afzal
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Gynaecological surgery ,Urological injury ,cystotomy ,Urinary tract injury ,Medicine - Abstract
Background: To determine the frequency of urinary tract injury during Obstetrics and Gynaecological surgery in the tertiary care teaching set up. Methods: In this descriptive study, all the patients who were admitted for obstetrical and gynaecological surgery irrespective of the time of procedure and level of surgical expertise were evaluated. Forty seven patients with bladder injury and six patients with ureteric injury were included. Site of injury, type and nature of surgical procedure, and therapeutic success rate with respect to time of diagnosis and treatment was analyzed. Injury was defined as entry into the urinary tract lumen, crushing, ligation or/and excision of urinary tract, leakage of urine, post operative hydronephrosis, or extravasation of contrast outside the urinary tract with or without renal damage that required surgical intervention. Results: The injury incidence in obstetrics emergency and elective procedures was 0.69% with urinary bladder the most frequently injured organ (88.67%). No ureteric injury was recorded in obstetrical patients. In gynaecological patients ratio of injuries to bladder and ureter was 4.84%. Most of the ureteric injuries (50%) were encountered in emergency laparotomy, followed by malignant ovarian tumours (33.3%). Most of the injuries were picked and dealt during the same surgical session with 15% of the patients requiring reoperation. Outcome of the management was satisfactory with no renal damage and mortality. Conclusion: Good knowledge of pelvic anatomy and practicing the visualization of ureteric course in routine patients will be helpful to safeguard it during complicated cases.
- Published
- 2015
26. Minimizing, Recognizing, and Managing Hysteroscopic Complications
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Smith, Samuel, Azziz, Ricardo, editor, and Murphy, Ana Alvarez, editor
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- 1997
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27. Avoidance and Treatment of Urological Complications
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Chen, Roland N., MacFadyen, Bruce V., Jr., editor, Arregui, Maurice E., editor, Eubanks, Steve, editor, Olsen, Douglas O., editor, Peters, Jeffrey H., editor, Soper, Nathaniel J., editor, Swanström, Lee L., editor, and Wexner, Steven D., editor
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- 2004
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28. Urinary tract injury during hysterectomy: Does surgeon specialty and surgical volume matter?
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Khair E, Afzal F, Kulkarni S, Duhe' B, Hagglund K, and Aslam MF
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Background: Ureteral injury is a known complication of hysterectomies. Recent studies have attempted to correlate surgeon volume and experience with incidence of urinary tract injuries during hysterectomies. Some studies have reported that as surgeon volume increases, urinary tract injury rates decrease. To our knowledge, no studies have assessed the relationship between surgeon subspecialty and the rate of urinary tract injury rates during minimally invasive hysterectomy., Aim: To determine the incidence of urinary tract injury between urogynecologists, gynecologic oncologists, and general gynecologists., Methods: The study took place from January 1, 2016 to December 1, 2021 at a large community hospital in Detroit, Michigan. We conducted a retrospective chart review of adult patients who underwent minimally invasive hysterectomy. After we identified eligible patients, the surgeon subspecialty was identified and the surgeon's volume per year was calculated. Patient demographics, medical history, physician-dictated operative reports, and all hospital visits postoperatively were reviewed., Results: Urologic injury occurred in four patients (2%) in the general gynecologist group, in one patient (1%) in the gynecologic oncologist group, and in one patient (1%) in the urogynecologist group. When comparing high and low-volume surgeons, there was no statistically significant difference in urinary tract injury (1% vs 2%) or bowel injury (1% vs 0%). There were more complications in the low-volume group vs the high-volume group excluding urinary tract, bowel, or major vessel injury. High-volume surgeons had four (1%) patients with a complication and low-volume surgeons had 12 (4%) patients with a complication ( P = 0.04)., Conclusion: Our study demonstrated that there was no difference in the urinary tract injury rate in general gynecologists vs subspecialists, however our study was underpowered., Competing Interests: Conflict-of-interest statement: We have no conflicts of interest to disclose and there has been no financial support for this research that could have influenced the outcome. As the corresponding author, I confirm that the manuscript has been reviewed and approved for submission by all authors., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)
- Published
- 2023
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29. Urological complications following gynaecological surgery.
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Gopinath, Deepa and Jha, Swati
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Gynaecology surgery is the commonest cause of iatrogenic injury of the urinary tract. Rapidly evolving surgical techniques and gynaecological training involving less surgical experience compared to previous years means there is a need to proactively minimise this risk. If ureteric injury is unrecognised it can result in prolonged morbidity and potential loss of organ function. Injuries may be avoidable by preoperative assessment, attention to risk factors and meticulous surgical technique. Counselling patients regarding potential injury is important especially if there are pre-existing risk factors. A high index of suspicion and prompt evaluation may improve immediate recognition and thereby improve prognosis. Any delay in postoperative recovery especially with flank pain should raise the suspicion of urinary tract injury and prompt diagnostic evaluation should be undertaken. Surgical repair should be done by specialists with sufficient expertise and woman should be debriefed and followed up to improve patient satisfaction and reduce litigation rates. [ABSTRACT FROM AUTHOR]
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- 2016
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30. Hysterectomy for benign disease: clinical practice guidelines from the French College of Obstetrics and Gynecology.
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Deffieux, Xavier, Rochambeau, Bertrand de, Chene, Gautier, Gauthier, Tristan, Huet, Samantha, Lamblin, Géry, Agostini, Aubert, Marcelli, Maxime, and Golfier, François
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HYSTERECTOMY complications , *BENIGN tumors , *PHYSICIAN practice acquisitions , *VAGINAL hysterectomy , *POVIDONE-iodine , *ANTIBIOTIC prophylaxis , *HYSTERECTOMY , *PREOPERATIVE risk factors - Abstract
Objective: The objective of the study was to draw up French College of Obstetrics and Gynecology (CNGOF) clinical practice guidelines based on the best available evidence concerning hysterectomy for benign disease.Methods: Each recommendation for practice was allocated a grade, which depends on the level of evidence (clinical practice guidelines).Results: Hysterectomy should be performed by a high-volume surgeon (>10 hysterectomy procedures per year) (gradeC). Stimulant laxatives taken as a rectal enema are not recommended prior to hysterectomy (gradeC). It is recommended to carry out vaginal disinfection using povidone-iodine solution prior to hysterectomy (grade B). Antibiotic prophylaxis is recommended during hysterectomy, regardless of the surgical approach (grade B). The vaginal or laparoscopic approach is recommended for hysterectomy for benign disease (grade B), even if the uterus is large and/or the patient is obese (gradeC). The choice between these two surgical approaches depends on other parameters, such as the surgeon's experience, the mode of anesthesia, and organizational constraints (duration of surgery and medical economic factors). Vaginal hysterectomy is not contraindicated in nulliparous women (gradeC) or in women with previous cesarean section (gradeC). No specific hemostatic technique is recommended with a view to avoiding urinary tract injury (gradeC). In the absence of ovarian disease and a personal or family history of breast/ovarian carcinoma, the ovaries should be preserved in pre-menopausal women (grade B). Subtotal hysterectomy is not recommended with a view to reducing the risk of peri- or postoperative complications (grade B).Conclusion: The application of these recommendations should minimize risks associated with hysterectomy. [ABSTRACT FROM AUTHOR]- Published
- 2016
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31. Recognition and Management of Urologic Injuries With Laparoscopic Hysterectomy.
- Author
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DASSEL, MARK W., ADELMAN, MARISA R., and SHARP, HOWARD T.
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- *
HYSTERECTOMY , *URINARY organs , *LAPAROSCOPIC surgery , *ANATOMY , *WOUNDS & injuries ,PREVENTION of surgical complications - Abstract
Injuries to the urinary tract during laparoscopic hysterectomy are quite rare, but are among the most serious injuries that occur during gynecologic surgery. Injury rates among subtypes of laparoscopic hysterectomy have been found to be similar. The most effective way to avoid urinary tract injury is knowledge of urinary tract anatomy and careful and thoughtful dissection. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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32. Laparoscopic Hysterectomy and Urinary Tract Injury: Experience in a Health Maintenance Organization.
- Author
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Tan-Kim, Jasmine, Menefee, Shawn A., Reinsch, Caryl S., O'Day, Cristina H., Bebchuk, Judith, Kennedy, John S., Whitcomb, Emily L., and O'Day, Cristina H
- Abstract
Study Objectives: To evaluate the incidence, detection, characteristics, and management of urinary tract injury in a cohort undergoing laparoscopic hysterectomy, and to identify potential risk factors for urinary tract injury with laparoscopic hysterectomy.Design: Retrospective analysis (Canadian Task Force classification II-2).Setting: Kaiser Permanente San Diego Medical Center, 2001 to 2012.Patients: Women who underwent attempted laparoscopic hysterectomy for benign indications.Interventions: Total laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy, and laparoscopic supracervical hysterectomy.Measurements and Main Results: Demographic and clinical characteristics, surgical techniques, and perioperative complications were abstracted from the medical record. Multivariable logistic regression analysis assessed independent risk factors for ureteral or bladder injury.Results: A total of 3523 patients (mean age, 45.9 ± 8.0 years; median parity, 2; range, 0-10), with a median body mass index (BMI) of 29 kg/m(2) (range, 16-72 kg/m(2)), underwent laparoscopic hysterectomy; 20% had intraoperative cystoscopy. The incidence of urinary tract injury was 1.3% (46 of 3523); of the 46 patients with injuries, 19 (0.54%) had ureteral injuries, 25 (0.71%) had bladder injuries, and 2 (0.06%) had both types. Of the 21 ureteral injuries, 6 (29%) were diagnosed intraoperatively and 15 (71%) were diagnosed postoperatively, including 4 with normal intraoperative cystoscopy. Of the 27 bladder injuries, 23 (85%) were identified intraoperatively. In multivariable logistic analysis, a BMI of 26 to 30 kg/m(2) (compared with >30 kg/m(2)) was associated with an increased risk of ureteral injury, and a BMI ≤25 kg/m(2) (compared with >30 kg/m(2)) and the presence of endometriosis were associated with an increased risk of bladder injury.Conclusion: Urinary tract injury occurred in 1.3% of laparoscopic hysterectomies, with ureteral injuries almost as common as bladder injuries. Normal intraoperative cystoscopy findings did not exclude the presence of ureteral injury. [ABSTRACT FROM AUTHOR]- Published
- 2015
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- View/download PDF
33. CO2 Cystoscopy for Evaluation of Ureteral Patency
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T.D. Pereira, Marco Aurelio Pinho Oliveira, Felipe Vaz Lima, T.S. Raymundo, and Diogo Eugenio Abreu da Silva
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Urinary system ,Laparoscopic hysterectomy ,Obstetrics and Gynecology ,Bladder distension ,Cystoscopy ,Perioperative ,Distension ,Cystoscopies ,Surgery ,Urinary tract injury ,Medicine ,business - Abstract
Gynecologic surgery is associated with various perioperative complications, especially urinary tract injuries. Intraoperative cystoscopy plays an important role in allowing assessment of the bladder to ensure the absence of injuries. Verification of the urinary jets from the ureters is a fundamental step that is not always easy to accomplish. Dyes are frequently used, but these are not always available and are associated with adverse effects. The present study aimed to demonstrate the use of CO2 as a medium for distension during cystoscopy. A total of 47 patients underwent CO2 cystoscopy after laparoscopic hysterectomy (n = 26) or bladder endometriosis nodule resection (n = 21). In all patients, the ureteral jets were readily identified, leaving no doubt as to their patency. The median interval between the onset of cystoscopy and the view of jetting from both ureteral ostia was 145 seconds (range, 80–300 seconds). All cystoscopies were normal, and no patient had any signs of accidental urinary tract injury in the follow-up period. Two patients experienced mild urinary tract infection. This cystoscopy technique using CO2 is fast, easy, safe, and efficient. We recommend bladder distension with CO2 as a reasonable alternative technique when cystoscopy is required during gynecologic procedures.
- Published
- 2019
34. The incidence, causes, and management of lower urinary tract injury during total laparoscopic hysterectomy
- Author
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Adnan Budak, Abdurrahman Hamdi İnan, Ahkam Göksel Kanmaz, and Emrah Beyan
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Adult ,medicine.medical_specialty ,Urinary system ,Urinary Bladder ,Endometriosis ,Total laparoscopic hysterectomy ,Hysterectomy ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Ureter ,Urethral Diseases ,Urinary tract injury ,Humans ,Medicine ,Intraoperative Complications ,030219 obstetrics & reproductive medicine ,Cesarean Section ,business.industry ,Incidence (epidemiology) ,Urinary Bladder Diseases ,Obstetrics and Gynecology ,Middle Aged ,medicine.disease ,Surgery ,Dissection ,medicine.anatomical_structure ,Reproductive Medicine ,030220 oncology & carcinogenesis ,Female ,Laparoscopy ,business ,Complication - Abstract
Determining the incidence and causes of lower urinary tract injury in patients undergoing total laparoscopic hysterectomy and examining the procedures applied for management.Patients who underwent total laparoscopic hysterectomy in a large referral center between 1 January 2015 and 31 October 2017 for benign gynecological reasons were included in the study. Patients who underwent laparoscopic supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy and robot-assisted laparoscopic hysterectomy were not included in this study. The hospital records of all patients included in the study were examined and the incidence, causes and management of lower urinary tract injuries were reviewed.Total lower urinary tract injury rate was found as 2.01%, and these injuries were evaluated separately as bladder and ureter injuries. All the bladder injuries had occurred on the posterior wall of the bladder during vesicouterine dissection; six cases were intraoperatively detected and one case was detected on the first postoperative day. Most of ureteral injury cases were detected in the early postoperative period (75%). The rates of previous cesarean section and endometriosis were significantly higher in patients with injury to the bladder and ureter than in the control group (p0,001). There was no significant difference between the patients with lower urinary tract injury and the control group regarding uterine weight, estimated blood loss, bilateral salpingo-oophorectomy, the presence and location of fibroids, and laparoscopic or vaginal closure of the vaginal cuff.Laparoscopic hysterectomy may be a good option in appropriate patients, but in case of previous cesarean section and endometriosis cases, patients should be informed about the possible complications in detail before the operation and care should be taken during dissection.
- Published
- 2019
35. A case of total laparoscopic hysterectomy for uterine cervical cystic adenomyosis. -Two techniques to avoid urinary tract injury
- Author
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Shinichi Yoshikoshi, Takashi Imai, Rie Minami, Yuka Ametani, Hiroshi Funamoto, Ayaka Yamaguchi, and Satoshi Tanimura
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medicine.medical_specialty ,business.industry ,Urinary tract injury ,Medicine ,Total laparoscopic hysterectomy ,Adenomyosis ,business ,medicine.disease ,Surgery - Published
- 2019
36. Cystoscopy at the time of incontinence and prolapse surgery
- Author
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Evelyn Hall, Lauren E. Stewart, and Cassandra L. Carberry
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medicine.medical_specialty ,Urinary system ,Lower risk ,Pelvic Organ Prolapse ,03 medical and health sciences ,Gynecologic Surgical Procedures ,0302 clinical medicine ,medicine ,Urinary tract injury ,Humans ,030212 general & internal medicine ,Intraoperative Complications ,Surgical repair ,Pelvic organ ,Intraoperative Care ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,General surgery ,Prolapse surgery ,Obstetrics and Gynecology ,Cystoscopy ,Urinary Incontinence ,Urologic Surgical Procedures ,Female ,Complication ,business - Abstract
PURPOSE OF REVIEW This article provides an update on the use of cystoscopy at the time of prolapse and incontinence surgery. RECENT FINDINGS Iatrogenic lower urinary tract injury is a known complication of antiincontinence procedures and surgical repair of pelvic organ prolapse. Intraoperative cystoscopy improves detection of lower urinary tract injuries in women undergoing pelvic floor surgery. The pelvic surgeon has a number of agents available to aid in the cystoscopic visualization of ureteral efflux. When injuries of the urinary tract are identified and treated intraoperatively, there is decreased morbidity, lower healthcare costs, and a lower risk of litigation than when detection is delayed. Therefore, many organizations, including the American College of Obstetricians and Gynecologists (ACOG), the American Urogynecologic Society (AUGS), and the American Urological Association (AUA) recommend cystoscopy at the time of pelvic floor surgery. SUMMARY Cystoscopy should be universally employed at the time of prolapse and incontinence surgery, except in instances of isolated repair of the posterior compartment.
- Published
- 2018
37. Wireless cystoscope the future of cystoscopy
- Author
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Nikolaos Kathopoulis, Ioannis Chatzipapas, Panagiota Siemou, and Atthanasios Protopapas
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medicine.medical_specialty ,Light source ,medicine.diagnostic_test ,Computer science ,business.industry ,Cystoscope ,medicine ,Urinary tract injury ,Wireless ,Medical physics ,Cystoscopy ,business ,Wireless camera - Abstract
Cystoscopy during a hysterectomy may decrease the rate of lower urinary tract injury. Our department has developed a new wireless endoscopic setup that couples a rigid 30 degree , 4-mm cystoscope with a wireless camera modified with a special adapter. We used a portable and rechargeable light source. Two cases performed with the new setup are presented in the videos. This report presents the use of a wireless, low-cost and portable camera throughout the course of cystoscopy and the results are promising. The new technique is feasible and easy reproducible and could contribute to making cystoscopy during gynecologic surgery cost-effective.
- Published
- 2021
38. Previous cesarean section and risk of urinary tract injury during laparoscopic hysterectomy: a meta-analysis.
- Author
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Xu, Yinghua, Wang, Qiming, and Wang, Furan
- Subjects
- *
HYSTERECTOMY , *CESAREAN section , *URINARY organs , *RELATIVE medical risk , *DISEASE risk factors , *WOUNDS & injuries - Abstract
Introduction and hypothesis: Today laparoscopic hysterectomy (LH) can be performed safely and effectively, even for women with a previous history of cesarean section (CS). However, it is unclear whether the risk of urinary tract injury increases with previous CS during LH. Methods: PubMed and Embase databases were searched for all studies on previous history of CS and risk of urinary tract injuries during and after LH. Reference lists of the identified studies, reviews, and other relevant publications were also searched. Urinary tract injuries or related complications were the outcomes of interest. Meta-analysis was conducted using an inverse-variance weighted random-effects model. Results: A total of 7 studies including 3,191 patients were identified in the meta-analysis. Overall, the pooled relative risk (RR) and the corresponding 95 % confidence interval (CI) of urinary tract injury were 3.48 (1.86-6.50) for previous CS compared with no previous CS. However, only two studies reported sufficient data on ureteral injury, and the combined RR was 1.83 (95 % CI 0.19-17.26). All seven studies reported the outcomes of bladder injury, and the pooled RR was 3.75 (95 % CI 1.96-7.17). Stratified analyses showed a basically consistent result with the overall analysis except for that by 1-2 times of previous CS (RR 2.32, 95 % CI 0.56-9.56). Conclusions: Previous CS is significantly associated with development of bladder injury during LH. No significant association was found yet between previous CS and risk of ureteral injury. Given the limited number of studies, more future studies are required to confirm the associations. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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39. Urological Injuries in Obstetrics and Gynaecological Surgery.
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Afzal, M. and Iqbal, Nargis
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- *
URINARY organs , *GYNECOLOGIC surgery , *OBSTETRICS surgery , *TERTIARY care , *BLADDER injuries , *WOUNDS & injuries - Abstract
Background: To determine the frequency of urinary tract injury during Obstetrics and Gynaecological surgery in the tertiary care teaching set up. Methods: In this descriptive study, all the patients who were admitted for obstetrical and gynaecological surgery irrespective of the time of procedure and level of surgical expertise were evaluated. Forty seven patients with bladder injury and six patients with ureteric injury were included. Site of injury, type and nature of surgical procedure, and therapeutic success rate with respect to time of diagnosis and treatment was analyzed. Injury was defined as entry into the urinary tract lumen, crushing, ligation or/and excision of urinary tract, leakage of urine, post operative hydronephrosis, or extravasation of contrast outside the urinary tract with or without renal damage that required surgical intervention. Results: The injury incidence in obstetrics emergency and elective procedures was 0.69% with urinary bladder the most frequently injured organ (88.67%). No ureteric injury was recorded in obstetrical patients. In gynaecological patients ratio of injuries to bladder and ureter was 4.84%. Most of the ureteric injuries (50%) were encountered in emergency laparotomy, followed by malignant ovarian tumours (33.3%). Most of the injuries were picked and dealt during the same surgical session with 15% of the patients requiring reoperation. Outcome of the management was satisfactory with no renal damage and mortality. Conclusion: Good knowledge of pelvic anatomy and practicing the visualization of ureteric course in routine patients will be helpful to safeguard it during complicated cases. [ABSTRACT FROM AUTHOR]
- Published
- 2015
40. 52 Lower urinary tract injury and the role of cystoscopy at the time of hysterectomy for gynecologic cancer
- Author
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C.E. Painter, S. Dessi, M. Ritterman Weintraub, Eve F Zaritsky, Olga Ramm, and Lue-Yen Tucker
- Subjects
medicine.medical_specialty ,Hysterectomy ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Gynecologic cancer ,medicine ,Urology ,Urinary tract injury ,Obstetrics and Gynecology ,Cystoscopy ,business - Published
- 2021
41. Ureteral stenting in laparoscopic colorectal surgery.
- Author
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Speicher, Paul J., Goldsmith, Zachariah G., Nussbaum, Daniel P., Turley, Ryan S., Peterson, Andrew C., and Mantyh, Christopher R.
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- *
URETER surgery , *SURGICAL stents , *LAPAROSCOPIC surgery , *COLON surgery , *COMORBIDITY , *HEALTH outcome assessment - Abstract
Abstract: Background: Few studies have examined the current status of ureteral stent use or the indications for stenting, particularly in laparoscopic colorectal surgery. This study examines current national trends and predictors of ureteral stenting in patients undergoing major colorectal operations and the subsequent effects on perioperative outcomes. Methods: The 2005–2011 National Surgical Quality Improvement participant user files were used to identify patients undergoing laparoscopic segmental colectomy, low anterior resection, or proctectomy. Trends in stent use were assessed across procedure types. To estimate the predictors of stent utilization, a forward-stepwise logistic regression model was used. A 3:1 nearest neighbor propensity match with subsequent multivariable adjustment was then used to estimate the impact of stents. Results: A total of 42,311 cases were identified, of which 1795 (4.2%) underwent ureteral stent placement. Predictors of stent utilization included diverticular disease, need for radical resection (versus segmental colectomy), recent radiotherapy, and more recent calendar year. After adjustment, ureteral stenting appeared to be associated with a small increase in median operative time (44 min) and a trivial increase in length of stay (5.4%, P < 0.001). However, there were no significant differences in morbidity or mortality. Conclusions: We describe the clinical predictors of ureteral stent usage in this patient population and report that while stenting adds to operative time, it is not associated with significantly increased morbidity or mortality after adjusting for diagnosis and comorbidities. Focused institutional studies are necessary in the future to address the utility of ureteral stents in the identification and possible prevention of iatrogenic injury. [Copyright &y& Elsevier]
- Published
- 2014
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42. Comparison of the safety and efficacy between the prone split-leg and Galdakao-modified supine Valdivia positions during endoscopic combined intrarenal surgery: A multi-institutional analysis
- Author
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Tatsuya Hattori, Takahiro Yasui, Takaaki Inoue, Atsushi Okada, Shinsuke Okada, Kazumi Taguchi, Tomoki Okada, Shuzo Hamamoto, Tadashi Matsuda, Kengo Kawase, and Ryosuke Chaya
- Subjects
medicine.medical_specialty ,Leg ,Supine position ,medicine.diagnostic_test ,Febrile urinary tract infection ,business.industry ,Urology ,Retrospective cohort study ,Computed tomography ,Endoscopy ,Patient Positioning ,Surgery ,Surgical time ,Prone position ,Kidney Calculi ,Urinary tract injury ,medicine ,Humans ,Complication ,business ,Nephrostomy, Percutaneous ,Retrospective Studies - Abstract
OBJECTIVES To evaluate the safety and efficacy of the prone split-leg and the Galdakao-modified supine Valdivia positions during endoscopic combined intrarenal surgery. METHODS A multi-institutional, retrospective cohort study was conducted between January 2014 and December 2018. The stone-free and complication rates were compared between the prone split-leg and the Galdakao-modified supine Valdivia positions. Anatomical variations were evaluated using contrast-enhanced computed tomography imaging. RESULTS In total, 118 and 100 patients underwent endoscopic combined intrarenal surgery in the prone split-leg and Galdakao-modified supine Valdivia positions, respectively. Renal punctures in the prone split-leg position were predominantly executed through the lower calyces (78.0%), whereas those in the Galdakao-modified supine Valdivia position were primarily performed through the middle calyces (64.0%; P
- Published
- 2020
43. Urinary tract injuries during cesarean delivery: long-term outcome and management
- Author
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Shira Stern, Ofer N. Gofrit, Guy Hidas, Myriam Safrai, and Doron Kabiri
- Subjects
medicine.medical_specialty ,Urinary system ,Urinary Bladder ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Urinary tract injury ,medicine ,Humans ,030212 general & internal medicine ,Cesarean delivery ,Urinary Tract ,reproductive and urinary physiology ,Severe complication ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,High prevalence ,business.industry ,Cesarean Section ,Incidence ,Bladder injury ,Obstetrics and Gynecology ,female genital diseases and pregnancy complications ,Surgery ,surgical procedures, operative ,Pediatrics, Perinatology and Child Health ,Female ,Ureter injury ,Morbidity ,business - Abstract
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.
- Published
- 2020
44. Needs Assessment for Lower Urinary Tract Injury Curriculum for FPMRS Fellowships
- Author
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Marlene M. Corton, Kimberly Kenton, and Margaret G. Mueller
- Subjects
genetic structures ,Urology ,education ,030232 urology & nephrology ,MEDLINE ,Vesicovaginal fistula ,Education ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Urinary tract injury ,Medicine ,Humans ,Fellowships and Scholarships ,Intraoperative Complications ,Urinary Tract ,Curriculum ,Accreditation ,Medical education ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Program director ,Plastic Surgery Procedures ,medicine.disease ,United States ,Obstetrics ,Education, Medical, Graduate ,Gynecology ,Needs assessment ,Urologic Surgical Procedures ,Surgery ,Female ,Clinical Competence ,business ,Needs Assessment ,Graduation - Abstract
Objective The aim of this study was to determine the level and types of training Accreditation Council for Graduate Medical Education-accredited programs use for female pelvic medicine and reconstructive surgery (FPMRS) fellows' education on lower urinary tract injuries (LUTIs). Methods Two surveys were developed to assess the need for LUTI curriculum from both program director (PD) and fellow vantages through a multistage process, including review by knowledgeable colleagues, cognitive interviews, and pilot testing. Surveys were distributed in an electronic link via e-mail to graduating fellows and program directors from each of the 58 Accreditation Council for Graduate Medical Education-accredited FPMRS programs. Results Thirty-four graduating FPMRS fellows (71%) and 39 FPMRS PDs (67%) completed the survey. Both PDs and fellows responded that both the evaluation and management of LUTI were necessary to FPMRS training. The majority of PDs use a combination of didactics and hands-on learning in the operating room (60% and 71%). Only 40% and 30% incorporate simulation into the curriculum to address LUTI. Graduating fellows report low numbers of procedures to evaluate and manage LUTI. Specifically, only 15% of fellows graduate with greater than 2 ureteral reimplantations and 44% graduate with no minimally invasive abdominal vesicovaginal fistula repairs. The majority of graduating fellows reported feeling prepared to evaluate for LUTI, but nearly one third do not feel ready to independently manage LUTI upon graduation. Conclusions FPMRS PDs and fellows agree that the evaluation and management of LUTI are important; however, most programs use only didactics and hands-on learning in the operating room with extremely low case volumes, leading to decreased proficiency.
- Published
- 2020
45. Evaluation of Strategies to Prevent Urinary Tract Injury in Minimally Invasive Gynecologic Surgery: A Systematic Review
- Author
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Katie Propst, Mary Pat Harnegie, and Beri Ridgeway
- Subjects
medicine.medical_specialty ,Hysterectomy ,business.industry ,Urinary system ,medicine.medical_treatment ,Obstetrics and Gynecology ,CINAHL ,Bladder catheter ,Cochrane Library ,Surgery ,Adult women ,Gynecologic Surgical Procedures ,Evaluation Studies as Topic ,Urinary Tract Infections ,medicine ,Urinary tract injury ,Humans ,Minimally Invasive Surgical Procedures ,Female ,Ureteral Catheters ,business - Abstract
To systematically review tools for the prevention of urinary tract injury in adult women undergoing minimally invasive gynecologic surgery.A medical librarian (M.P.H.) searched Ovid Medline 1946 to, Ovid Embase 1929 to, CINAHL 1965 to, Cochrane Library 1974 to, Web of Science 1926 to, and SCOPUS 1974 to present on April 2 and April 3, 2020.Articles evaluating strategies for the prevention of urinary tract injury at the time of minimally invasive gynecologic surgery were included. Articles that were nongynecologic, nonhuman, and nonadult were excluded. If a study did not describe the surgical approach or type of surgical procedures performed, it was excluded. If the study population was50% gynecologic or50% minimally invasive, it was excluded. Articles evaluating techniques for the diagnosis or management of injury, rather than prevention, were excluded.The search yielded 2344 citations; duplicates were removed, inclusion criteria were applied, and 9 studies remained for analysis. Three studies evaluated bladder catheters, and 6 evaluated ureteral catheters. In the 3 studies evaluating bladder catheters, there were no urinary tract injuries. Urinary tract infection was greater in women who received a bladder catheter. In the studies evaluating the use of ureteral catheters, we found inconsistent reporting and heterogeneity that precluded meta-analysis. The results of the available studies do not indicate that ureteral catheters decrease the risk of injury, and indicate that they increase morbidity.The evidence is insufficient to support the routine use of bladder catheters or ureteral catheters for the prevention of urinary tract injury at the time of minimally invasive gynecologic surgery.
- Published
- 2020
46. Urological complications following gynaecological surgery.
- Author
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Gopinath, Deepa and Jha, Swati
- Subjects
URETER injuries ,URINARY organs ,GYNECOLOGIC surgery ,IATROGENIC diseases ,SURGICAL complications ,WOUNDS & injuries - Abstract
Abstract: Gynaecology surgery is the commonest cause of iatrogenic injury of the urinary tract. There is a need to minimize this risk with rapidly evolving surgical techniques and gynaecological training involving lesser surgical experience compared to previous years. Ureteric injury can often be unrecognized and results in prolonged morbidity and potential loss of organ function. Risk factors exist in most cases and injuries may be avoidable by preoperative assessment and meticulous surgical technique. Counselling patients regarding potential injury is important especially if there are pre- existing risk factors. A high index of suspicion and prompt evaluation may improve immediate recognition and thereby improve prognosis. Any delay in postoperative recovery especially with flank pain should raise the suspicion of urinary tract injury and prompt diagnostic evaluation should be undertaken. Surgical repair should be done by specialists with sufficient expertize and woman should be debriefed and followed up to improve patient satisfaction and reduce litigation rates. [Copyright &y& Elsevier]
- Published
- 2013
- Full Text
- View/download PDF
47. Simulated management of urinary tract injury during robotic pelvic surgery utilizing the porcine model
- Author
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Philippe E. Spiess and Mitchel S. Hoffman
- Subjects
medicine.medical_specialty ,Swine ,030232 urology & nephrology ,Health Informatics ,Pelvis ,03 medical and health sciences ,0302 clinical medicine ,Ureter ,Animal model ,Robotic Surgical Procedures ,Urinary tract injury ,Animals ,Medicine ,Trigone of urinary bladder ,Education, Graduate ,Intraoperative Complications ,Urinary Tract ,Simulation Training ,Pelvic surgery ,Intraoperative Care ,business.industry ,Cystotomy ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Intraoperative management ,Models, Animal ,Female ,Laparoscopy ,business ,Complication - Abstract
Urologic injury is an infrequent but serious complication of pelvic surgery. Training in the assessment and management of this injury might be enhanced through animated simulation. Our objective was to assess the intraoperative management of urologic injury with robotic pelvic surgery using a simulated injury animal model. We used a female domestic pig to create three types of urologic injury, which we then managed with robotically assisted surgery. An edited video of the model was assessed by 14 senior learners and 10 attending faculty. The assessments included key competencies and domains of fidelity. A scale of poor, fair, or good was utilized. The defects and repairs simulated those seen in humans, both anatomically and surgically, although deficiencies were noted. Related to fidelity of the anatomy of the ureter and bladder, lower ratings were given for some of the key competencies (determining the relationship to the trigone, ureteral mobilization, repair of all 3 injuries). The porcine model for simulation of urologic injury during robotically assisted pelvic surgery may be useful for training purposes.
- Published
- 2018
48. Clinical retrospective analysis of urinary tract injury at the time of total laparoscopic hysterectomy
- Author
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X.G. Lin, G.H. Jiang, X. Yuan, Qing Wang, Jiming Chen, Q. Li, Hongyan Gao, Yi Ding, and D. Yang
- Subjects
medicine.medical_specialty ,Reproductive Medicine ,business.industry ,Urinary tract injury ,medicine ,Retrospective analysis ,Obstetrics and Gynecology ,Total laparoscopic hysterectomy ,business ,Surgery - Published
- 2018
49. A case of edematous occlusion of the right ureteral orifice in total laparoscopic hysterectomy: A possibility of urinary tract injury indicated in the transvaginal specimen collection
- Author
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Yuko Fukatsu, Fujiyuki Inaba, and Masayuki Onodera
- Subjects
medicine.medical_specialty ,Right ureteral orifice ,Specimen collection ,business.industry ,Occlusion ,medicine ,Urinary tract injury ,Total laparoscopic hysterectomy ,business ,Surgery - Published
- 2018
50. Cystoscopy at the Time of Benign Hysterectomy: A Decision Analysis
- Author
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Lauren A. Cadish, Jonathan P. Shepherd, and Beri Ridgeway
- Subjects
medicine.medical_specialty ,Hysterectomy ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Bladder injury ,Obstetrics and Gynecology ,General Medicine ,Cystoscopy ,medicine.disease ,Urinoma ,Surgery ,Ureteral injury ,medicine ,Urinary tract injury ,business ,Complication ,Decision analysis - Abstract
Background Gynecologists debate the optimal use for intraoperative cystoscopy at the time of benign hysterectomy. Although adding cystoscopy leads to additional up-front cost, it may also enable intraoperative detection of a urinary tract injury that may otherwise go unnoticed. Prompt injury detection and intraoperative repair decreases morbidity and is less costly than postoperative diagnosis and treatment. Because urinary tract injury is rare and not easily studied in a prospective fashion, decision analysis provides a method for evaluating the cost associated with varying strategies for use of cystoscopy. Objective The objective of the study was to quantify costs of routine cystoscopy, selective cystoscopy, or no cystoscopy with benign hysterectomy. Study Design We created a decision analysis model using TreeAge Pro. Separate models evaluated cystoscopy following abdominal, laparoscopic/robotic, and vaginal hysterectomy from the perspective of a third-party payer. We modeled bladder and ureteral injuries detected intraoperatively and postoperatively. Ureteral injury detection included false-positive and false-negative results. Potential costs included diagnostics (imaging, repeat cystoscopy) and treatment (office/emergency room visits, readmission, ureteral stenting, cystotomy closure, ureteral reimplantation). Our model included costs of peritonitis, urinoma, and vesicovaginal/ureterovaginal fistula. Complication rates were determined from published literature. Costs were gathered from Medicare reimbursement as well as published literature when procedure codes could not accurately capture additional length of stay or work-up related to complications. Results From prior studies, bladder injury incidence was 1.75%, 0.93%, and 2.91% for abdominal, laparoscopic/robotic, and vaginal hysterectomy, respectively. Ureteral injury incidence was 1.61%, 0.46%, and 0.46%, respectively. Hysterectomy costs without cystoscopy varied from $884.89 to $1121.91. Selective cystoscopy added $13.20–26.13 compared with no cystoscopy. Routine cystoscopy added $51.39–57.86 compared with selective cystoscopy. With the increasing risk of injury, selective cystoscopy becomes cost saving. When bladder injury exceeds 4.48–11.44% (based on surgical route) or ureteral injury exceeds 3.96–8.95%, selective cystoscopy costs less than no cystoscopy. Therefore, if surgeons estimate the risk of injury has exceeded these thresholds, cystoscopy may be cost saving. However, for routine cystoscopy to be cost saving, the risk of bladder injury would need to exceed 20.59–47.24% and ureteral injury 27.22–37.72%. Model robustness was checked with multiple 1-way sensitivity analyses, and no relevant thresholds for model variables other than injury rates were identified. Conclusion While routine cystoscopy increased the cost $64.59–83.99, selective cystoscopy had lower increases ($13.20–26.13). These costs are reduced/eliminated with increasing risk of injury. Even a modest increase in suspicion for injury should prompt selective cystoscopy with benign hysterectomy.
- Published
- 2019
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