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–Early detection and treatment of postoperative acute kidney injury is essential.–How to prevent acute kidney injury after cytoreductive surgery is unclear.–Intraoperative hematuria is related to postoperative acute kidney injury.–Hematuria is easily detectable and may reflect ureter injury.–This may improve long-term outcomes for patients undergoing cytoreductive surgery.

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]

Robotic-assisted laparoscopic prostatectomy (RALP) is the surgical standard of care for patients with localized prostate cancer. Although uncommon, the procedure involves a potential risk of injury to adjacent anatomical structures. We report on a unique case of iatrogenic ureteral injury during RALP that required subsequent robotic-assisted laparoscopic ureteral reimplantation for definitive repair. A 57-year-old male underwent RALP using the Da Vinci Xi system (Intuitive Surgical, Sunnyvale, CA). The procedure was unremarkable and a 20 French Foley catheter was placed with plans for removal after one week following a negative cystogram. On postoperative day two, his creatinine level elevated to 2.69 mg/dL from a baseline of 1.40 mg/dL, left-sided flank pain increased, and non-contrast CT imaging revealed moderate left proximal hydroureteronephrosis and no other abnormalities. Aside from mild nausea on postoperative day one, he had no other symptoms. An integrated stent was unable to be placed by urology at this time. Subsequently, a left percutaneous nephrostomy tube was placed under fluoroscopic guidance. After this intervention, the patient's symptoms improved and the decision was made not to proceed with operative re-exploration at this time to attempt identification of the obstruction. Three weeks later, the patient underwent cystoscopy with attempted left retrograde ureteropyelography and left ureteroscopy due to suspected distal obstruction. This revealed complete obstruction of the intramural portion of the ureter, presumed to be secondary to suture ligation at the time of the vesicourethral anastomosis. Seven weeks postoperatively, the patient underwent robotic-assisted laparoscopic left ureteral reimplantation. Thereafter, the patient had a resolution of his left hydroureteronephrosis and acute kidney injury. This case describes an intravesical ureteral ligation during RALP. An iatrogenic intravesical ureteral ligation has far less guiding literature than a more common ureteral transection. Additionally, ureteral transection is often identified and managed intraoperatively, while the ureteral ligation presented in this case is far less likely to be apparent during surgery. Early identification will allow for rapid reoperation to manage the injury. We hypothesize that during the vesicourethral anastomosis, the left intramural ureter was ligated. Importantly, with the use of a 3-0 V-Loc stitch for the vesicourethral anastomosis, its barbed nature would not facilitate simple surgical removal. In conclusion, when performing RALP, the depth of the bladder-sided vesicourethral anastomotic stitch should be carefully considered to avoid a similar injury., 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, Baetzhold et al.)

Injury of intraabdominal structures by rupturing the anterior longitudinal ligament is a known complication of discectomy. Despite its very low incidence, it has a high mortality. Although various minimally invasive methods are defined for discectomy, no significant reduction in this complication has been achieved. Positioning of the patient, aggressive discectomy, and deep-seated use of disc forceps are important risk factors. The aim of this study is to share our experience with modified instruments to minimize the risk of vascular and visceral injury during discectomy in surgically treated 405 patients with lumbar disc herniation. We routinely perform preoperative depth measurements at the level of lumbar disc herniations for the patients undergoing lumbar disc surgery and check the neighborhood with the prevertebral structures. During the operation, we perform discectomy with custom disc forceps that were labeled with centimeter measurements in accordance with these lengths. We performed discectomy on 405 patients using these forceps between January 2015 and May 2021. In this retrospective study, disc depth measurements differed according to disc levels and gender. Disc depth was longer in males at all lumbar disc levels. It is very important to avoid vascular and visceral injuries for spinal surgeons. For this reason, we believe that knowing the safe preoperative discectomy depth and area and using centimeter-labeled disc forceps is the best method to prevent such complications. [ABSTRACT FROM AUTHOR]

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Small bowel obstruction is one of the most common urgent surgical conditions, caused by a variety of factors, with adhesions, malignancies, and hernias, internal and external, being the most common. Many types of internal hernias have been described in the literature; however, internal hernia caused by the ureter as a secondary complication of ureteroplasty is rare and only a few cases have been reported worldwide. This presentation discusses an interesting case of small bowel obstruction accompanied by obstruction of the urinary tract due to an internal hernia caused by the ureter. A 58-year-old female presented to the emergency department (ED) with acute pain in the abdominal and right lumbar region. Her surgical history includes hysterectomy, right ureter injury, and ureteroplasty performed 10 years ago. Clinical examination showed tenderness in the lower abdomen, positive Giordano's sign on the right, and metallic bowel sounds. A computer tomography scan revealed right-sided hydronephrosis, absence of excretion in the right urinary tract, and dilated loops of the small intestine. An exploratory laparoscopy revealed a small bowel loop strangulated by the ureter, followed by laparotomy, resection of a segment of the ileum, oblique anastomosis, and reimplantation of the right ureter. The patient was discharged eight days postoperatively without any complications. This case underscores the significance of surgical history in order to recognize even rarer causes of small bowel obstruction., 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, Permekerlis et al.)

The iatrogenic ureter injury is a common medical negligence in the gynecology, abdominal, and urinary surgeries. Anatomically, the ureter is covered by peritoneum and connective tissue, and the doctor cannot observe it directly in surgery. The ureter injury may cause significant complications for patients and medical disputes. It is important to indicate the ureter position for aided surgery of the doctor. To provide ureter position for doctors in the laparoscopic surgery, we design an image-guided endoscope system that includes a novel endoscopic video system with a visible-light camera and an infrared camera. The visible-light camera is to capture the coeliac image and the infrared camera is to capture the ureter position, simultaneously. To extract accurate ureter position in the infrared image, we also propose a self-adaptive threshold segmentation algorithm to extract the real ureter position as accurately as possible. The self-adaptive threshold and scattering factor are taken in to full account for the ureter segmentation. In addition, the scattering property of light is also discussed to choose the optimal light. Finally, we design and develop the image-guided endoscope system, and experiment it on the animal. The experimental results demonstrate that the proposed image-guided endoscope system achieves 93.8% and 90.6% in terms of true positive rate and positive predictive value, respectively. The processing speed of the proposed algorithm can reach about 165 frames per second (f/s), and the frame rate is far faster than the frame rate (30 f/s) of the traditional endoscope system. The accuracy and processing ability of the system can satisfy the clinical demand. The iatrogenic ureter injury may be decreased when the surgeons perform the operations with the ureter position displayed in real time.

Abstract Objective To evaluate the procedure of endoscopic surgery for ureterovaginal fistula (UVF) and its clinical efficacy. Materials and methods A retrospective analysis of 46 patients needing treatment for UVF with endourology technology was conducted (all patients had unilateral ureteric injury, 27 left and 19 right). Transurethral retrograde ureteric stenting or realignment retrograde/antegrade approach stenting was used to treat the fistula, and the relation between treatment and prognosis was analyzed. Results One case failed, the patient undergoing percutaneous nephrostomy instead. Success was achieved in 45 cases, and urinary leakage was stopped 48 h after surgery. Of the 45 patients operated on, 16 had their double-J stents removed after 3–6 months, and 29 needed replacement every 6–12 months. In a postoperative follow-up of 6–36 months, 10 patients had recurrent stenosis needing ureteroscopic endoureterotomy or reexpansion with a balloon. No other complications occurred. Conclusions Endoscopic surgery is an effective technology in the treatment of UVF, with the advantages of being effective, reliable, less invasive, and readily accepted by patients.

Objective: The aim of this study was to evaluate the feasibility and safety of a total laparoscopic hysterectomy (TLH) without the use of a uterine manipulator in women with benign indications for hysterectomy.Study Design: Between January 2011 and January 2020, 1023 patients underwent a TLH without the use of any type of uterine manipulator. The indications for hysterectomy were all benign conditions. The patients' details were obtained from the hospital medical records and the indications for hysterectomy, the surgical data and the intra and postoperative complications were evaluated. All operations were performed by the same surgical team.Results: The median age was 48.2 years, while the BMI ranged from between 26.2 kg/m2 and 47.8 kg/m2. A small percentage of the women were menopausal (278, 27 %) and, following a detailed consultation with 563 (55 %) of the patients, we performed a TLH with adnexectomy. The mean operative time was 78 min (43-168 min), while the estimated blood loss was 59 mL (20-260 ml) and the mean uterine weight was 255 g (40-1510 g). There was no case of conversion to laparotomy. A blood transfusion was required for 14 patients (1.4 %), while there was one case of ureteral injury and three cases where the bladder was opened and fixed laparoscopically. The average hospital stay was 1.1 days, with only 38 patients staying for two or more days. In the long term, we had five cases (0.5 %) of vaginal vault dehiscence and one case of vaginal vault hematoma.Conclusion: A TLH without the use of a uterine manipulator is a feasible and safe procedure. While it is perhaps a more demanding procedure for young doctors, when performed by well-trained and experienced laparoscopic surgeons, the procedure entails a short operative time and a low complications rate. As such, it should be the first step in the training of young doctors for performing laparoscopic radical hysterectomies. [ABSTRACT FROM AUTHOR]

Background and Objectives: Acute urologic complications, including bladder and/or ureteric injury, are rare but known events occurring at the time of caesarean section (CS). Delayed or inadequate management is associated with increased morbidity and poor long-term outcomes. We conducted this study to identify the risk factors for urologic injuries at CS in order to inform obstetricians and patients of the risks and allow management planning to mitigate these risks. Materials and Methods: We reviewed all cases of urological injuries that occurred at CS surgeries in a tertiary university centre over a period of four years, from January 2016 to December 2019. To assess the risk factors of urologic injuries, a case-control study of women undergoing caesarean delivery was designed, matched 1:3 to randomly selected women who had an uncomplicated CS. Electronic medical records and operative reports were reviewed for socio-demographic and clinical information. Descriptive and univariate analyses were used to characterize the study population and identify the risk factors for urologic complications. Results: There were 36 patients with urologic complications out of 14,340 CS patients, with an incidence of 0.25%. The patients in the case group were older, had a lower gestational age at time of delivery and their newborns had a lower birth weight. Prior CS was more prevalent among the study group (88.2 vs. 66.7%), as was the incidence of placenta accreta and central praevia. In comparison with the control group, the intraoperative blood loss was higher in the case group, although there was no difference among the two groups regarding the type of surgery (emergency vs. elective), uterine rupture, or other obstetrical indications for CS. Prior CS and caesarean hysterectomy were risk factors for urologic injuries at CS. Conclusions: The major risk factor for urological injuries at the time of CS surgery is prior CS. Among patients with previous CS, those who undergo caesarean hysterectomy for placenta previa central and placenta accreta are at higher risk of surgical haemostasis and complex urologic injuries involving the bladder and the ureters.

Objectives: To report a large series of vesicovaginal fistula, and to assess the incidence of ureteric injury in association with vesicovaginal fistula. Methods: We retrospectively reviewed a prospective database of patients with vesicovaginal fistula referred to our center between 2004 and 2016. Data on patient demographics, fistula etiology, mode of repair, and any associated ureteric injury and its treatment were noted. Results: Overall, 116 patients (median age 49 years, range 23–88 years) were referred for management of vesicovaginal fistula during the study period. Four of these patients (3.4%) had associated ureteric injury, one of whom had bilateral injury. Ureteric obstruction alone was noted in two patients, ureterovaginal fistula alone in one patient, and bilateral ureteric obstruction and ureterovaginal fistula in one patient. All ureteric injuries were managed with simultaneous reimplantation into the bladder at the time of vesicovaginal fistula repair. Five patients had post‐radiotherapy vesicovaginal fistula, and the remainder were post‐surgical. Three patients with post‐radiotherapy vesicovaginal fistula proceeded to primary diversion. Conclusions: Ureteric injury is far less common than previously reported, occurring in <5% of patients presenting with vesicovaginal fistula. It can be successfully managed, and it remains the major indication for abdominal repair of vesicovaginal fistula. [ABSTRACT FROM AUTHOR]

Objective To investigate the anatomic relationship between ureter and oblique lateral interbody fusion access by using contrast-enhanced computed tomographic urography. Methods Contrast-enhanced computed tomographic urography data of 234 patients were retrospectively analyzed. The angle of inclination (∠α) of bilateral ureters, the angle between bilateral surgical accesses (∠β), the insertion angle of surgical access (∠γ), and the angle between ureter and outer margin of ipsilateral surgical access (∠ε) at L2/3, L3/4, and L4/5 levels were measured and analyzed. Results ∠α gradually increased from L2/3 to L4/5. ∠β gradually decreased from L2/3 to L4/5, and at each level the left-sided ∠β was larger than right-sided ∠β. ∠ε were positive at L2/3 and left-sided L3/4. The right-sided ∠ε at L3/4 and the bilateral sided ∠ε at L4/5 were negative, and the right-sided ∠ε at L4/5 had the largest absolute value. Conclusions The bilateral ureters gradually descents from the lateral margin to the anteromedial margin on the surface of psoas major muscle. The range of bilateral surgical accesses for oblique lateral interbody fusion gradually decreases from L2/3 to L4/5, and the left-sided access is larger than the right-sided when at the same level. Ureters at the right-sided L3/4 level and bilateral L4/5 levels are at high risk of being injured. In particular, the right ureter at the L4/5 level is most likely to be injured. [ABSTRACT FROM AUTHOR]

Intra Uterine Contraceptive Device (IUCD) is the most popular method of reversible contraception in India because of their high efficacy for fertility regulation, low-risk, low-cost, and lack of required maintenance. Uterine perforation remains one of the most serious complications, with an incidence 0.87 per 1000 insertions. The IUCD strings are used to monitor and remove the device. Missing IUCD strings are observed in about 5% of the users. Such patients require localisation of the device using Transvaginal Scan (TVS) and X-Ray, and combined hysterolaparoscopic approach for its retrieval. Hereby we report a case of young primipara, who consulted a local practitioner requesting IUCD removal, as she was planning to conceive her second child. On examination, Cu-T threads were not found. A plain X-Ray of the pelvis was reported as: Cu-T limbs seen in the left side of the pelvis, “in the region of uterus”. Blind attempts led to damage to ovary and uterus along with the ureter. By reporting this case, we hope to raise awareness on the management of misplaced IUCD, among primary care givers; and the need for set protocols on the management of such cases.

The ureter injury occasionally happens in the gynecology, abdominal and urinary surgeries. The medical negligence may cause severe problems for the hospital, and mental pressure for the doctors. Furthermore, the serious accident brings painful complications for the patients. Thus, it is necessary to locate the ureter, which is covered by peritoneum and connective tissue, for the assisted surgery. The aim is to detect the ureter position, and avoid iatrogenic ureter injury. In order to indicate the ureter position in surgery, we propose an image-guided endoscope system that has both traditional functions of the endoscope system and the additional function of ureter detection. We design an infrared-based pipe that its shape is similar to the ureteral catheter to mark the ureter, and use the multi-spectral camera that can capture both the visual and infrared light to obtain the endoscopic images. To extract the precise contour of the ureter, we propose a hardware-aided detection method, and a high-efficient segmentation algorithm. The hardware-aided method is used to recognize the kind of the captured images. Then the ureter position is extract by the segmentation algorithm. Before the image segmentation, the image enhancement and denoising algorithms are executed to reduce the noise level of images. The extracted contour of the ureter is fused with visible-light images to generate the endoscopic images highlighting the location of ureter. Experimental results indicate that the proposed system can achieve 83.54% and 88.38% of true positive rate (TPR) and positive predictive value (PPV ) respectively. In addition, the frame rate is about 25 frames per second (f/s), which reaches the real-time performance. We proposed a novel image-guided endoscope system for the ureter detection, and the ureter position can be displayed during the surgery. The proposed system may reduce the ureter injury in surgery, and improve the surgical success rate. [ABSTRACT FROM AUTHOR]

Intra Uterine Contraceptive Device (IUCD) is the most popular method of reversible contraception in India because of their high efficacy for fertility regulation, low-risk, low-cost, and lack of required maintenance. Uterine perforation remains one of the most serious complications, with an incidence 0.87 per 1000 insertions. The IUCD strings are used to monitor and remove the device. Missing IUCD strings are observed in about 5% of the users. Such patients require localisation of the device using Transvaginal Scan (TVS) and X-Ray, and combined hysterolaparoscopic approach for its retrieval. Hereby we report a case of young primipara, who consulted a local practitioner requesting IUCD removal, as she was planning to conceive her second child. On examination, Cu-T threads were not found. A plain X-Ray of the pelvis was reported as: Cu-T limbs seen in the left side of the pelvis, "in the region of uterus". Blind attempts led to damage to ovary and uterus along with the ureter. By reporting this case, we hope to raise awareness on the management of misplaced IUCD, among primary care givers; and the need for set protocols on the management of such cases. [ABSTRACT FROM AUTHOR]

Iatrogenic ureteral injuries are a significant complication during pelvic surgery, requiring a multidisciplinary approach for optimal repair. When a ureteral injury is suspected postoperatively, abdominal imaging is essential to determine the type of injury and thus the timing and method of reconstruction. That can be performed either by a CT pyelogram or by an ureterography-cystography with or without ureter stenting. Although technological advancements and minimally invasive surgery have been gaining ground over open complex surgeries, renal autotransplantation is a well-established technique of proximal ureter repair and should be highly considered when dealing with a severe injury. We hereby report the case of a patient with a recurrent ureter injury and multiple laparotomies treated with autotransplantation, without any major morbidities or change in their quality of life. In every case, a personalized approach for each patient and consultation with experienced transplant experts (surgeons, urologists, and nephrologists) is advised., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Rekouna et al.)

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]

Objectives: To identify risk factors associated with lower urinary tract injury at the time of performing hysterectomy for benign indications. Methods: We conducted a multi-center case-control study of women undergoing hysterectomy for benign disease. Cases were identified via ICD-9 codes for lower urinary tract injury at the time of hysterectomy from 2007 to 2011: controls were two subsequent hysterectomies following the index case in the same institution that did not have lower urinary tract injury. Logistic regression was used to perform univariate and multivariate comparisons between groups. Results: At 7 centers, 135 cases and 270 controls were identified. Cases comprised 118 bladder injuries and 25 ureteral injuries; 8 women had both bladder and ureteral injury. Bladder injury was associated with a history of prior cesarean section OR 2.9 (95 % CI 1.7-5), surgery by a general obstetrician and gynecologist OR 2.4 (95 % CI 1.2-5.2), and total abdominal hysterectomy OR1.9 (95%CI 1.06-3.4). Ureteral injury was more likely among women who underwent laparoscopic-assisted vaginal hysterectomy (LAVH) OR 10.4 (95%CI 2.3-46.6) and total abdominal hysterectomy (TAH) OR 4.7 (95 % CI 1.4-15.6). Conclusion: Bladder injury at the time of benign hysterectomy is associated with a prior history of Cesarean section and TAH as well as surgery by generalist OB-GYN; ureteral injury is associated with LAVH and TAH. [ABSTRACT FROM AUTHOR]

Background: Ureter injuries are the most dreaded complication in gynecological surgery. Some risk factors for the occurrence of urinary tract injuries are known, but clear guidelines to prevent ureter injuries during laparoscopic hysterectomy (LH) are lacking. The aim of this study was to analyze all known ureter injuries that occurred during LH for a benign indication in the Netherlands, in order to identify patient- and surgeon-related risk factors. Methods: Ninety-five LH-performing gynecologists were asked to recall all cases of known ureter injuries during LH in their hospital. After identification of ureter injuries, a structured interview was performed with a questionnaire that focused on the identification of predisposing factors which could account for the cause of the injury. Results: Forty-one injuries were detected in 37 patients (4 bilateral ureter injuries) in a 20-year period. The questionnaire could be completed for 31 cases. Predisposing factors were retrospectively assessed and classified into categories: patient-related (i.e., deep infiltrating endometriosis, intraligamentary fibroids) ( n = 18), surgeon-related (insufficient experience and/or technique) ( n = 16), or both (insufficient experience and difficult case) ( n = 8). According to earlier-mentioned recommendations in a Delphi study among experts, in 48.4 % of these ureter injury cases, more than one of the recommended techniques or predisposing conditions were not applied or available. Only one ureter injury was diagnosed during the LH; the mean time to diagnose the injury was 29 days. Conclusions: Incomplete learning curve, insufficient applied technique such as coagulation of the uterine artery without the use of a uterine manipulator, and/or from the contralateral side and/or without previously performed ureterolysis in case of distorted anatomy may be considered as the main predisposing factors. [ABSTRACT FROM AUTHOR]

The aim of this review was to characterize the possible urological manifestations of rectal disorders in case of the involvement of the genitourinary system, as well as the symptoms of urological diseases involving the distal part of the large bowel. In urological and coloproctological practice, the anatomical and physiological proximity of the distal part of the intestine and the urogenital organs is of importance (for example, the common innervation of the pelvic organs, the synergy of the pelvic floor muscles, etc.), since it results in similar clinical manifestations, making it difficult to make a diagnosis. The most relevant and common urological and proctological diseases, including prostatitis, intestinovesical and rectourethral fistulas, damage to the ureter and bladder during colorectal surgery are discussed in the article. Particular attention is paid to the interdisciplinary cooperation of urologists and proctologists and the frequent need for their joint participation in the diagnosis and treatment of the pelvic organs disorders.

Introduction: Ureteral replacement by a loop of defunctionalized ileum was described more than 2 centuries ago and continues to be a therapeutic option at present. This series describes the technique of bilateral ureteral replacement with ileum. Aim: To report 4 cases of bilateral ileal ureteral replacement performed at our institution, its indications, the surgical technique, complications, and a review of the literature. Material and Method: We report 4 cases of extensive bilateral ureteral injury of different etiologies, whose treatment with curative intent was to replace the damaged ureter with a isoperistaltic small bowel segment. Results: The surgical technique used was standard in all cases. There were no intraoperative complications and only one patient had hyperchloremic acidosis. No patient has shown loss of renal function in the long-term follow up. Conclusion: Is an effective therapeutic, safe and reproducible technique to replacement of major bilateral ureteral injuries, independent of the original cause. [ABSTRACT FROM AUTHOR]

Abstract: Iatrogenic ureteric injuries are an uncommon but difficult problem to manage. Although ureteric injury has been reported during hernia surgery in adults, it has not been reported in children during herniotomy. An 18-month-old male child underwent repair of an inguinal hernia and developed postoperative anuria. Investigations revealed that the patient had a solitary kidney and had injury to the solitary ureter. We successfully managed this patient using the vermiform appendix to replace a segment of the injured ureter. The possible mechanism of injury and the relevant literature are discussed. [Copyright &y& Elsevier]

BACKGROUND Hysterectomy guidelines highlight an increase in urinary tract injuries with laparoscopic hysterectomy (LH). This national survey analyses complications of LH, abdominal hysterectomy (AH) and vaginal hysterectomy (VH). METHODS A prospective cohort undergoing hysterectomy for benign indications during 2006 was drawn from 53 hospitals in Finland; all communal hospitals participated. Detailed questionnaires covered surgical data and intra- and post-operative major and minor complications, for which risk factors were analysed by a multivariate logistic regression model adjusted for surgical data and patient characteristics. RESULTS Major complications rates in AH (n= 1255, 24%), LH (1679, 32%) and VH (2345, 44%) were 4.0, 4.3 and 2.6%, and total complications rates were 19.2, 15.4 and 11.7%, respectively. Logistic regression showed no statistically significant differences between approaches for any organ injuries or other major complications. Most bladder and bowel injuries (88 and 83%), but not ureter injuries (10%), were recognized intra-operatively. The ureter injury rate was low after LH (0.3%), as it was after other types of hysterectomy. Compared with LH, AH increased the odds of wound infection, and was an independent risk factor for urinary infections and febrile events. Compared with AH, LH and VH both presented a higher risk for pelvic infection; surgically treated equally often regardless of the type of hysterectomy. No differences in complications emerged between LH and VH. Obesity was a risk factor for many infections. Surgical adhesiolysis [odds ratio (OR) 2.41, 95% confidence interval (CI) 1.38–4.21] was the strongest single risk factor for major complications as a whole. Bladder injury was associated with a history of caesarean section (OR 4.01, 95% CI 2.06–7.83) and with a large uterus ≥500 g (OR 2.88, 95% CI 1.05–7.90), while bowel injury was associated with adhesiolysis (OR 29.07, 95% CI 7.17–117.88). CONCLUSIONS FINHYST is a large prospective hysterectomy study illustrating actual complications. Whenever possible, hysterectomy should be minimally invasive. [ABSTRACT FROM PUBLISHER]

Complications following cesarean and hysterectomy operations can occur, one of which is ureter ligation. Aims: Urological injuries that occur during hysterectomy are rare but important causes of morbidity. It was aimed to investigate in this case report whether there was any evidence to support malpractice in Court. Case Report: The patient was a woman in her 343 week of pregnancy with familial Mediterranean fever (FMF) and nephrotic syndrome with renal amyloidosis. Preterm operational diagnosis was placenta previa totalis and repeat cesarean section was performed with confirmed consent. When the placenta spontaneously ruptured, hysterectomy was undertaken. Ureter ligation with acute renal failure was diagnosed later in another hospital. Left ureterolysis and dilation were performed. Discussion: Under normal operational processes, the ureter should be protected from ligation and cutting. The complication of ureter ligation and cutting incidence is reported in approximately 1.5% of procedures. The operation should be performed by skilled gynecologists and urologists trained in surgery of the pelvic retroperitoneum. This patient had FMF, amyloidosis and renal tubular necrosis due to hemorrhage. These factors were the main cause for acute renal failure. The precipitating factor was left ureter ligation, which accelerated the development of renal failure. For this reason, diagnosis should be done as soon as possible. The interval between operation and diagnosis of this case and treatment was approximately 46 days. Conclusions: Iatrogenic ureteric injury is still a major cause of harm and concern in hysterectomy. The patient is entitled to indemnification from hospital A. The patient was in great need of treatment as a result of the complication. Delayed diagnosis and treatment of ureter ligation is a neglect of the patient's rights. Our Social Security needs to be expanded to cover not only operations but also resulting complications. [ABSTRACT FROM AUTHOR]

Abstract: Ureter injuries are a well-known complication of gynecologic surgery and a frequent cause of medicolegal problems. Because there are no randomized, controlled trials and the available studies are small series and case reports, the evidence on which to base treatment is weak. We therefore reviewed the complete English-language literature of ureter repair since 1990. In total, 608 ureter injuries were reported. Although it is widely believed that for laceration or section the prognosis is affected by a delay in diagnosis, we could not find evidence to substantiate this. An obstruction requires stenting only. For a laceration, stenting with suturing was more effective than stenting only (p = .006). A ureter anastomosis was successful in over 94% of cases either by laparotomy or laparoscopy. In conclusion, the literature data are scanty and heterogeneous and do not permit solid conclusions. Evidence, however, is emerging that a laceration should be treated by stenting and suturing. A ureter anastomosis over a stent could become a valid option especially when performed by laparoscopy. [Copyright &y& Elsevier]

Background and Objectives: Acute urologic complications, including bladder and/or ureteric injury, are rare but known events occurring at the time of caesarean section (CS). Delayed or inadequate management is associated with increased morbidity and poor long-term outcomes. We conducted this study to identify the risk factors for urologic injuries at CS in order to inform obstetricians and patients of the risks and allow management planning to mitigate these risks. Materials and Methods: We reviewed all cases of urological injuries that occurred at CS surgeries in a tertiary university centre over a period of four years, from January 2016 to December 2019. To assess the risk factors of urologic injuries, a case-control study of women undergoing caesarean delivery was designed, matched 1:3 to randomly selected women who had an uncomplicated CS. Electronic medical records and operative reports were reviewed for socio-demographic and clinical information. Descriptive and univariate analyses were used to characterize the study population and identify the risk factors for urologic complications. Results: There were 36 patients with urologic complications out of 14,340 CS patients, with an incidence of 0.25%. The patients in the case group were older, had a lower gestational age at time of delivery and their newborns had a lower birth weight. Prior CS was more prevalent among the study group (88.2 vs. 66.7%), as was the incidence of placenta accreta and central praevia. In comparison with the control group, the intraoperative blood loss was higher in the case group, although there was no difference among the two groups regarding the type of surgery (emergency vs. elective), uterine rupture, or other obstetrical indications for CS. Prior CS and caesarean hysterectomy were risk factors for urologic injuries at CS. Conclusions: The major risk factor for urological injuries at the time of CS surgery is prior CS. Among patients with previous CS, those who undergo caesarean hysterectomy for placenta previa central and placenta accreta are at higher risk of surgical haemostasis and complex urologic injuries involving the bladder and the ureters. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. • Ureter injury in obstetrics hysterectomy: case report • Ureter injury in placenta accreta spectrum • Ureter injury in obstetric hysterectomy with placenta accreta spectrum [ABSTRACT FROM AUTHOR]