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Orsi M, Somigliana E, Paraboschi I, Reschini M, Cassardo O, Ferrazzi E, Perugino G. Urological injuries complicating pregnancy-related hysterectomy: Analysis of risk factors and proposal to improve the quality of care. Eur J Obstet Gynecol Reprod Biol 2025; 306:106-111. [PMID: 39818087 DOI: 10.1016/j.ejogrb.2025.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Accepted: 01/10/2025] [Indexed: 01/18/2025]
Abstract
PURPOSE While strategies aimed at preventing urological injuries complicating hysterectomy for gynaecological indications and placenta accreta surgery have been proposed, a comprehensive model for pregnancy-related hysterectomy (PRH) is lacking. The aim of this study was to investigate risk factors for urological complications of obstetric hysterectomy, and to propose strategies to improve the quality of care. METHODS This retrospective study of patients undergoing PRH was conducted in an academic centre between 2009 and 2022. Surgical lesions of the urinary tract were defined by the need for direct repair or subsequent additional urological interventions. Univariate and multivariate analyses were performed to identify determinants of urological injuries. RESULTS Among 141 patients undergoing obstetric hysterectomy, 25 (17.7 %) experienced urological injuries (22 bladder lesions, three ureteral lesions). Bladder injuries were repaired intraoperatively, while ureteral lesions were diagnosed 2-5 weeks after surgery. After adjustment for confounding variables, the number of previous caesarean deliveries (p = 0.006) and intraoperative estimated blood loss (p = 0.002) were independently associated with urological complications. CONCLUSION The burden of urological complications during obstetric hysterectomy is high. Subtotal hysterectomy can be considered in selected cases to reduce the risk of ureteral injury, while postoperative ultrasonographic screening of the urinary tract and analysis of serum markers may facilitate early detection of undiagnosed ureteral complications.
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Affiliation(s)
- Michele Orsi
- Obstetrics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Paraboschi
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Marco Reschini
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ottavio Cassardo
- Obstetrics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Enrico Ferrazzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giuseppe Perugino
- Obstetrics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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2
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McClelland PH, Liu T, Johnson RP, Glenn C, Ozuner G. Iatrogenic urinary injuries in colorectal surgery: outcomes and risk factors from a nationwide cohort. Tech Coloproctol 2024; 28:137. [PMID: 39361072 DOI: 10.1007/s10151-024-03008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 08/30/2024] [Indexed: 10/05/2024]
Abstract
BACKGROUND Iatrogenic urinary injury (IUI) can lead to significant complications after colorectal surgery, especially when diagnosis is delayed. This study analyzes risk factors associated with IUI and delayed IUI among patients undergoing colorectal procedures. METHODS Adults undergoing colorectal surgery between 2012 and 2021 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP®) database. Multivariable regression analysis was used to determine risk factors and outcomes associated with IUI and delayed IUI. RESULTS Among 566,036 patients, 5836 patients (1.0%) had IUI after colorectal surgery, of whom 236 (4.0%) had delayed IUI. Multiple preoperative risk factors for IUI and delayed IUI were identified, with disseminated cancer [adjusted odds ratio (aOR) 1.4, 95% confidence interval (CI) 1.2-1.5; p < 0.001] and diverticular disease [aOR 1.1, 95% CI 1.0-1.2; p = 0.009] correlated with IUI and increased body mass index [aOR 1.6, 95% CI 1.2-2.1; p = 0.003] and ascites [aOR 5.6, 95% CI 2.1-15.4; p = 0.001] associated with delayed IUI. Laparoscopic approach was associated with decreased risk of IUI [aOR 0.4, 95% CI 0.4-0.5; p < 0.001] and increased risk of delayed IUI [aOR 1.8, 95% CI 1.4-2.5; p < 0.001]. Both IUI and delayed IUI were associated with significant postoperative morbidity, with severe multiorgan complications seen in delayed IUI. CONCLUSIONS While IUI occurs infrequently in colorectal surgery, unrecognized injuries can complicate repair and cause other negative postoperative outcomes. Patients with complex intra-abdominal pathology are at increased risk of IUI, and patients with large body habitus undergoing laparoscopic procedures are at increased risk of delayed IUI.
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Affiliation(s)
- P H McClelland
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY, 11215, USA.
| | - T Liu
- Division of Colorectal Surgery, Baylor St. Luke's Medical Group, The Woodlands, TX, USA
| | - R P Johnson
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - C Glenn
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - G Ozuner
- Department of Colorectal Surgery, Arnot Ogden Medical Center, Elmira, NY, USA
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3
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Menezes SD, Rao T. Innovative ICG Application in Benign Gynaecological Surgery: Enhancing Safety and Precision. Case Rep Obstet Gynecol 2024; 2024:1642315. [PMID: 39105141 PMCID: PMC11300066 DOI: 10.1155/2024/1642315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/20/2024] [Accepted: 07/18/2024] [Indexed: 08/07/2024] Open
Abstract
In the context of increased adoption of minimally invasive surgery for benign gynaecological conditions, this study underscores the paramount importance of patient safety. We explored the efficacy of indocyanine green (ICG), a fluorescent dye, in enhancing the visualisation of critical anatomical structures during complex laparoscopic procedures. Our methods involved the direct administration of ICG into the ureters for precise identification and dissection, as well as an innovative vaginal application to delineate the rectovaginal plane in cases with distorted pelvic anatomy. The study presented two cases: a laparoscopic hysterectomy for a multifibroid uterus and a case of advanced endometriosis with rectal involvement. Results indicated that ICG use significantly improved real-time visualisation of the ureters and the rectovaginal plane, which facilitated the surgeries and reduced the cognitive load on surgeons. There were no intraoperative complications, and the postoperative phase showed positive patient outcomes. In conclusion, the application of ICG in these laparoscopic surgeries proved to be a beneficial adjunct, suggesting its potential for broader application in benign gynaecological surgeries. Future research is warranted to explore additional uses of ICG, with a focus on enhancing patient safety and surgical efficacy.
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Affiliation(s)
- Summer Deah Menezes
- Obstetrics and Gynaecology DepartmentLiverpool Hospital, Locked Bag 7103 Liverpool 2170, Sydney, NSW, Australia
- University of New South WalesSouth Western Sydney Clinical SchoolLiverpool Hospital, Level 2, Clinical Building, Locked Bag 7103 Liverpool 2170, Sydney, NSW, Australia
| | - Tanushree Rao
- Obstetrics and Gynaecology DepartmentLiverpool Hospital, Locked Bag 7103 Liverpool 2170, Sydney, NSW, Australia
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Maheswaran R, Beisland C, Bergesen AK, Almås B. A delayed diagnosis of iatrogenic ureteral injury results in increased morbidity. Sci Rep 2024; 14:13771. [PMID: 38877070 PMCID: PMC11178925 DOI: 10.1038/s41598-024-63847-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
This study aimed to register and analyse outcomes after iatrogenic ureteral injuries (IUI) with special emphasis on potential consequences of a delayed diagnosis, and further to analyse if the incidence of IUI has changed during the study period. 108 patients treated for an IUI during 2001-2021 were included. Injuries due to endourological procedures, planned tumour resection and traumatic injuries were excluded. All relevant information to answer the research questions were entered into a database. Chi-square and t-tests were used for categorical and continuous variables respectively. Regression analysis was used to evaluate potential change of incidence in IUIs over time. Our results showed that most IUIs (74, 69%) were caused by gynaecological surgery. 49 (45%) had a delayed diagnosis (not diagnosed intraoperatively). Younger age (mean 50 vs 62 years, p < 0.001) and benign indication for laparoscopic hysterectomy (OR 8.0, p < 0.001) predisposed for a delayed diagnosis. Patients with a delayed diagnosis had a higher number of secondary injury related procedures (mean 4.6 vs 1.7, p < 0.001), hospital admissions (mean 3.0 vs 0.8, p < 0.001) and longer hospital stays (mean 20.6 vs 3.9 days p < 0.001) compared to patients with an intraoperative diagnosis. There was complete recovery for 91% of the patients. We did not observe any changes in IUI incidence during the study period. In conclusion, our study underlines that IUI can cause major morbidity for the patient affected if not diagnosed intraoperatively. Benign indication and younger age are predictors for a delayed diagnosis. The prognosis is good, with 91% full recovery. No significant changes in incidence of IUIs were observed.
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Affiliation(s)
- Rachel Maheswaran
- Department of Urology, Haukeland University Hospital, 5021, Bergen, Norway.
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne K Bergesen
- Department of Urology, Haukeland University Hospital, 5021, Bergen, Norway
| | - Bjarte Almås
- Department of Urology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Saito M, Kojima T, Komatsu K, Takusagawa S. Population Pharmacokinetic Modeling and Simulation of Pudexacianinium (ASP5354) for Dose Setting of a Phase 2 First-in-Patient Study: A Novel Imaging Agent for Intraoperative Ureter Visualization during Abdominopelvic Surgery. Clin Pharmacol Drug Dev 2024; 13:454-464. [PMID: 38135485 DOI: 10.1002/cpdd.1354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
Pudexacianinium (ASP5354) chloride is an indocyanine green derivative designed to enable enhanced ureter visualization during surgery. The objective of the present analysis was to determine appropriate doses of pudexacianinium for a phase 2, dose-ranging study (NCT04238481). Real-time urine pudexacianinium concentration is considered a good pharmacodynamic surrogate marker, since ureter visualization likely depends on its concentration in the ureter. Using plasma and urine concentrations of pudexacianinium from a phase 1 single-ascending-dose (0.1-24.0 mg) study in healthy participants, a 3-compartment population pharmacokinetic model with a urine output compartment was developed and effectively described the concentration-time profiles. The individual estimated glomerular filtration rates had a significant impact on drug clearance. Simulations suggested that a 1.0 mg intravenous injection would achieve target urine concentrations over 1 μg/mL (determined from previous nonclinical studies) for 3 hours postdose, assuming a urine production rate of 1.0 mL/min. Based on this simulation, doses of 0.3, 1.0, and 3.0 mg were proposed for the phase 2 study. The observed plasma concentrations were generally consistent with model predictions. For urine, although only limited data could be obtained due to the difficulties of spot urine collection from surgical patients, intraoperative ureter visualization was successful at 1.0 and 3.0 mg.
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McCarus SD, Shortridge EF, Kimura T, Feng Q, Han W, Jiang B. Long-term economic outcomes of ureteral injury in the United States. Curr Med Res Opin 2024; 40:325-333. [PMID: 37961772 DOI: 10.1080/03007995.2023.2283204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/08/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVES Ureteral injuries (UIs) during surgical procedures can have serious consequences for patients. Although UIs can result in substantial clinical burden, few studies report the impact of these injuries on payer reimbursement and patient cost-sharing. This retrospective study evaluated 30-day, 90-day, and 1-year healthcare resource utilization for patients with UIs and estimated patient and payer costs. METHODS Patients aged ≥ 12 years who underwent abdominopelvic surgery from January 2016 to December 2018 were identified in a United States claims database. Patients were followed for 1 year to estimate all-cause healthcare visits and costs for patients and payers. Surgeries resulting in UIs within 30 days from the surgery date were matched to surgeries without UIs to estimate UI-attributable visits and costs. RESULTS Five hundred and twenty-two patients with UIs were included. Almost a third (29.9%) of patients with UIs had outpatient surgery. Patients with UIs had slightly more healthcare visits and a 15.3% higher 30-day hospital readmission rate than patients without UIs. Patient costs due to UIs were not statistically significant, but annual payer costs attributable to UIs were $38,859 (95% CI = 28,142-49,576), largely driven by inpatient costs. CONCLUSIONS UIs add substantial cost for payers and result in more healthcare visits for patients. These findings highlight the importance of including inpatient and outpatient settings for UI prevention. Although UIs are rare, the associated patient and payer burdens are high; thus, protocols or techniques are needed to recognize and avert UIs as current guideline recommendations are lacking.
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Affiliation(s)
- Steven D McCarus
- Gynecological Surgery Department, Advent Health Winter Park Hospital, Winter Park, FL, USA
| | - Emily F Shortridge
- Health Economics and Outcomes Research, Astellas Pharma Global Development, Inc, Northbrook, IL, USA
| | - Tomomi Kimura
- Health Economics and Outcomes Research, Astellas Pharma Global Development, Inc, Northbrook, IL, USA
| | - Qi Feng
- Health Economics and Outcomes Research, Astellas Pharma Global Development, Inc, Northbrook, IL, USA
| | - Wei Han
- Health Economics and Outcomes Research, Astellas Pharma Global Development, Inc, Northbrook, IL, USA
| | - Baoguo Jiang
- Health Economics and Outcomes Research, Astellas Pharma Global Development, Inc, Northbrook, IL, USA
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7
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Zhao Y, Tan WJ. Ureteral Injury. Dis Colon Rectum 2023; 66:1421-1424. [PMID: 37594904 DOI: 10.1097/dcr.0000000000003032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
CASE SUMMARY A 70-year-old man underwent laparoscopic low anterior resection for a rectal adenocarcinoma after neoadjuvant chemoradiotherapy. Postoperatively, the patient had high drain volume output, with 800 mL of clear serous fluid being drained on the second postoperative day. Drain creatinine returned as 300 mmol/L, with a corresponding serum creatinine of 100 mmol/L. CT scan of the abdomen and pelvis confirmed a left ureteric injury with an associated urinoma. After urology consultation, the patient underwent a left ureteric reimplantation emergently.
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Affiliation(s)
- Yue Zhao
- Ministry of Health Holdings, Singapore
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8
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Yang Y, Gu S, Sang WL, Liu W, Wu SF. Technical, ergonomic and cognitive learning methodology in transumbilical single-port laparoscopic hysterectomy. Int J Gynaecol Obstet 2023; 163:158-166. [PMID: 37254585 DOI: 10.1002/ijgo.14883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/09/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE We introduced learning curves on a detailed step protocol and ergonomic aspect to determine key surgical points in transumbilical single-port laparoscopic hysterectomy (TSPLH) and to popularize both technical and cognitive methodology on laparoendoscopic single-site surgery (LESS). MATERIALS AND METHODS A retrospective analysis of 87 TSPLH procedures was conducted by a single surgeon in three learning stages. Technical, ergonomic, and cognitive steps were introduced, and surgical outcomes were analyzed. RESULTS Key production points in TSPLH include developing a clear retroperitoneal space, maintaining appropriate strength and direction with a vaginal manipulator, coagulating the uterine artery, and applying an improved vaginal stump suturing method. Technical factors included instrument domination, hand-eye coordination, and alternating hand functions. Ergonomic techniques focused on shoulder, elbow, arm, wrist, and finger movements, range of motion, muscle power, continuous forces, and flexibility. Improved cognitive factors such as confidence, decision-making, and communication were also observed. CONCLUSIONS The study aimed to form methodological education on TSPLH and LESS and benefit more surgeons. The detailed production and key ergonomic points will help guide self-learning and education.
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Affiliation(s)
- Ye Yang
- Obstetrics and Gynecology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Gu
- Trauma Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Lin Sang
- Orthopedics Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Liu
- Educational Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Su Fang Wu
- Obstetrics and Gynecology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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9
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de'Angelis N, Schena CA, Marchegiani F, Reitano E, De Simone B, Wong GYM, Martínez-Pérez A, Abu-Zidan FM, Agnoletti V, Aisoni F, Ammendola M, Ansaloni L, Bala M, Biffl W, Ceccarelli G, Ceresoli M, Chiara O, Chiarugi M, Cimbanassi S, Coccolini F, Coimbra R, Di Saverio S, Diana M, Dioguardi Burgio M, Fraga G, Gavriilidis P, Gurrado A, Inchingolo R, Ingels A, Ivatury R, Kashuk JL, Khan J, Kirkpatrick AW, Kim FJ, Kluger Y, Lakkis Z, Leppäniemi A, Maier RV, Memeo R, Moore EE, Ordoñez CA, Peitzman AB, Pellino G, Picetti E, Pikoulis M, Pisano M, Podda M, Romeo O, Rosa F, Tan E, Ten Broek RP, Testini M, Tian Wei Cheng BA, Weber D, Sacco E, Sartelli M, Tonsi A, Dal Moro F, Catena F. 2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery. World J Emerg Surg 2023; 18:45. [PMID: 37689688 PMCID: PMC10492308 DOI: 10.1186/s13017-023-00513-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023] Open
Abstract
Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France
- Faculty of Medicine, University of Paris Cité, Paris, France
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France.
| | - Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France
| | - Elisa Reitano
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Research Institute Against Digestive Cancer (IRCAD), 67000, Strasbourg, France
| | - Belinda De Simone
- Department of Minimally Invasive Surgery, Guastalla Hospital, AUSL-IRCCS Reggio, Emilia, Italy
| | - Geoffrey Yuet Mun Wong
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
| | - Aleix Martínez-Pérez
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Filippo Aisoni
- Department of Morphology, Surgery and Experimental Medicine, Università Degli Studi Di Ferrara, Ferrara, Italy
| | - Michele Ammendola
- Science of Health Department, Digestive Surgery Unit, University "Magna Graecia" Medical School, Catanzaro, Italy
| | - Luca Ansaloni
- Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Miklosh Bala
- Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Graziano Ceccarelli
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Italy
| | - Marco Ceresoli
- General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Riverside, CA, USA
| | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | - Michele Diana
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Research Institute Against Digestive Cancer (IRCAD), 67000, Strasbourg, France
| | | | - Gustavo Fraga
- Department of Trauma and Acute Care Surgery, University of Campinas, Campinas, Brazil
| | - Paschalis Gavriilidis
- Department of HBP Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | - Riccardo Inchingolo
- Unit of Interventional Radiology, F. Miulli Hospital, 70021, Acquaviva Delle Fonti, Italy
| | - Alexandre Ingels
- Department of Urology, Henri Mondor Hospital, University of Paris Est Créteil (UPEC), 94000, Créteil, France
| | - Rao Ivatury
- Professor Emeritus, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeffry L Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, University of Portsmouth, Southwick Hill Road, Cosham, Portsmouth, UK
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, EG23T2N 2T9, Canada
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology - Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ronald V Maier
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, General Regional Hospital "F. Miulli", Acquaviva Delle Fonti, Bari, Italy
| | - Ernest E Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Carlos A Ordoñez
- Division of Trauma and Acute Care Surgery, Fundación Valle del Lili, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Gianluca Pellino
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Manos Pikoulis
- 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Michele Pisano
- 1st General Surgery Unit, Department of Emergency, ASST Papa Giovanni Hospital Bergamo, Bergamo, Italy
| | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | | | - Fausto Rosa
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | | | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Emilio Sacco
- Department of Urology, Università Cattolica del Sacro Cuore Di Roma, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Alfredo Tonsi
- Digestive Diseases Department, Royal Sussex County Hospital, University Hospitals Sussex, Brighton, UK
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy.
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10
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Deng L, Tang S, Dou Y, Li Y, Liang Z, Wang Y. The efficacy of ureteroscopic triage in increasing the cure rate of the first-line treatment for a ureterovaginal fistula resulting from radical hysterectomy. Heliyon 2023; 9:e18389. [PMID: 37520954 PMCID: PMC10374918 DOI: 10.1016/j.heliyon.2023.e18389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023] Open
Abstract
Study objective To explore the effect of pretreatment with ureteroscopic triage for iatrogenic ureterovaginal fistula (UVF) resulting from radical hysterectomy. Design A retrospective cohort study. Setting Department of gynecology at a tertiary medical center. Patients Women diagnosed with UVF secondary to radical hysterectomy at our center between April 2008 to June 2018. Interventions The patients were divided into two groups according to whether pretreatment with ureteroscopic triage was performed. Those in the non-triage group underwent retrograde placement of a double-J stent immediately following diagnosis as the first-line therapy. Patients in the triage group were first evaluated under ureteroscopy, their ureteral injuries were then classified into different grades and then underwent different treatments as the first-line therapy, including stent placement or reconstruction surgeries. The cure rate of the first-line therapy and the timeliness of the implementation of adjuvant radiotherapy were subsequently analyzed. Measurements and main results Ninety-eight UVF patients were included. The demographics, ECOG status, stage of cervical cancer (FIGO 2009), types and onset time of symptoms were not different between the two groups. There were 54 patients in the nontriage group, with an overall first-line cure rate of 70.4% and a timely implementation rate of adjuvant radiotherapy of 38.5%. There were 44 patients in the evaluation group, with an overall first-line cure rate of 93.2% and a timely implementation rate of adjuvant radiotherapy of 90.0%. The differences were statistically significant (p < 0.001). Conclusion Ureteroscopic triage of ureteral injuries can guide the selection of the optimal first-line therapy for patients with UVF secondary to radical hysterectomy, increase the cure rate and ensure the timely implementation of adjuvant radiotherapy.
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McCarus S, Alexandre AF, Kimura T, Feng Q, Han W, Shortridge EF, Lima RB, Schwartz J, Wexner SD. Abdominopelvic Surgery: Intraoperative Ureteral Injury and Prophylaxis in the United States, 2015-2019. Adv Ther 2023; 40:3169-3185. [PMID: 37227585 PMCID: PMC10272259 DOI: 10.1007/s12325-023-02515-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/04/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Preoperative ureteral catheterization/stenting (stenting) and intraoperative diagnostic cystoscopy (cystoscopy) may help prevent or identify intraoperative ureteral injuries (IUIs) during abdominopelvic surgery. In order to provide a comprehensive, single source of data for health care decision makers, this study aimed to catalog the incidence of IUI and rates of stenting and cystoscopy across a wide spectrum of abdominopelvic surgeries. METHODS We conducted a retrospective cohort analysis of United States (US) hospital data (October 2015-December 2019). IUI rates and stenting/cystoscopy use were investigated for gastrointestinal, gynecological, and other abdominopelvic surgeries. IUI risk factors were identified using multivariable logistic regression. RESULTS Among approximately 2.5 million included surgeries, IUIs occurred in 0.88% of gastrointestinal, 0.29% of gynecological, and 1.17% of other abdominopelvic surgeries. Aggregate rates varied by setting and for some surgery types were higher than previously reported, especially in certain higher-risk colorectal procedures. Prophylactic measures were generally employed at a relatively low frequency, with cystoscopy used in 1.8% of gynecological procedures and stenting used in 5.3% of gastrointestinal and 2.3% of other abdominopelvic surgeries. In multivariate analyses, stenting and cystoscopy use, but not surgical approach, were associated with a higher risk of IUI. Risk factors associated with stenting or cystoscopy, as well as those for IUI, largely mirrored the variables reported in the literature, including patient demographics (older age, non-White race, male sex, higher comorbidity), practice settings, and established IUI risk factors (diverticulitis, endometriosis). CONCLUSION Use of stenting and cystoscopy largely varied by surgery type, as did rates of IUI. The relatively low use of prophylactic measures suggests there may be an unmet need for a safe, convenient method of injury prophylaxis in abdominopelvic surgeries. Development of new tools, technology, and/or techniques is needed to help surgeons identify the ureter and avoid IUI and the resulting complications.
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Affiliation(s)
- Steven McCarus
- Gynecological Surgery, Advent Health Winter Park Hospital, Winter Park, FL, USA
| | - Ana Filipa Alexandre
- Health Economics and Outcomes Research, Astellas Pharma Europe B.V., Leiden, The Netherlands
| | - Tomomi Kimura
- Data Science, Astellas Pharma, Inc., Northbrook, IL, USA
| | - Qi Feng
- Data Science, Astellas Pharma, Inc., Northbrook, IL, USA
| | - Wei Han
- Data Science, Astellas Pharma, Inc., Northbrook, IL, USA
| | - Emily F Shortridge
- Medical Affairs, Astellas Gene Therapies, Astellas Pharma, Inc., 1 Astellas Way, Northbrook, IL, 60062, USA
| | - Robson Barbosa Lima
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Jason Schwartz
- Medical Affairs, Astellas Gene Therapies, Astellas Pharma, Inc., 1 Astellas Way, Northbrook, IL, 60062, USA.
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
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Khair E, Afzal F, Kulkarni S, Duhe' B, Hagglund K, Aslam MF. Urinary tract injury during hysterectomy: Does surgeon specialty and surgical volume matter? World J Methodol 2023; 13:18-25. [PMID: 37035027 PMCID: PMC10080498 DOI: 10.5662/wjm.v13.i2.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/02/2023] [Accepted: 02/13/2023] [Indexed: 03/15/2023] Open
Abstract
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.
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Affiliation(s)
- Emilee Khair
- Department of Obstetrics and Gynecology, Ascension St John, Detroit, MI 48236, United States
| | - Fareeza Afzal
- Department of Obstetrics and Gynecology, Ascension St John, Detroit, MI 48236, United States
| | - Sanjana Kulkarni
- Department of Obstetrics and Gynecology, Ascension St John, Detroit, MI 48236, United States
| | - Beaux Duhe'
- Department of Obstetrics and Gynecology, St. George's University School of Medicine, Great River, NY 11739, United States
| | - Karen Hagglund
- Department of Medical Research, Ascension St John, Detroit, MI 48236, United States
| | - Muhammad Faisal Aslam
- Department of Obstetrics and Gynecology, Ascension St John, Detroit, MI 48236, United States
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Liang C, Liu P, Kang S, Li W, Chen B, Ji M, Chen C. Risk factors for and delayed recognition of genitourinary fistula following radical hysterectomy for cervical cancer: a population-based analysis. J Gynecol Oncol 2023; 34:e20. [PMID: 36603848 PMCID: PMC9995873 DOI: 10.3802/jgo.2023.34.e20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 10/25/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE This study aimed to identify the risk factors for genitourinary fistulas and delayed fistula recognition after radical hysterectomy for cervical cancer. METHODS This study was a retrospective analysis of data collected in the Major Surgical complications of Cervical Cancer in China (MSCCCC) database from 2004-2016. Data on sociodemographic characteristics, clinical characteristics, and hospital characteristics were extracted. Differences in the odds of genitourinary fistula development were investigated with multivariate logistic regression analyses, and differences in the time to recognition of genitourinary fistula were assessed by Kruskal-Wallis test. RESULTS In this study, 23,404 patients met the inclusion criteria. Surgery in a cancer center, a women's and children's hospital, a facility in a first-tier city, or southwest region, stage IIA, type C1 hysterectomy, laparoscopic surgery and ureteral injury were associated with a higher risk of ureterovaginal fistula (UVF) (p<0.050). Surgery in southwest region, bladder injury and laparoscopic surgery were associated with greater odds of vesicovaginal fistula (VVF) (p<0.050). Surgery at cancer centers and high-volume hospitals was associated with an increase in the median time to UVF recognition (p=0.016; p=0.005). International Federation of Gynecology and Obstetrics (FIGO) stage IIA1-IIB was associated with delayed recognition of VVF (p=0.040). CONCLUSION Intraoperative urinary tract injury and surgical approach were associated with differences in the development of UVFs and VVFs. Patients who underwent surgery in cancer centers and high-volume hospitals were more likely to experience delayed recognition of UVF. Patients with FIGO stage IIA1-IIB disease were more likely to experience delayed recognition of VVF.
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Affiliation(s)
- Cong Liang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shan Kang
- Department of Obstetrics and Gynecology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Weili Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Biliang Chen
- Department of Obstetrics and Gynecology, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Mei Ji
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Caulfield C, Wu D, Miller IS, Byrne AT, Mac Aonghusa P, Zhuk S, Cinelli L, Bannone E, Marescaux J, Gioux S, Diana M, March TL, Vahrmeijer AL, Cahill R, O’Shea DF. BF 2-Azadipyrromethene Fluorophores for Intraoperative Vital Structure Identification. Molecules 2023; 28:2167. [PMID: 36903411 PMCID: PMC10004488 DOI: 10.3390/molecules28052167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
A series of mono- and bis-polyethylene glycol (PEG)-substituted BF2-azadipyrromethene fluorophores have been synthesized with emissions in the near-infrared region (700-800 nm) for the purpose of fluorescence guided intraoperative imaging; chiefly ureter imaging. The Bis-PEGylation of fluorophores resulted in higher aqueous fluorescence quantum yields, with PEG chain lengths of 2.9 to 4.6 kDa being optimal. Fluorescence ureter identification was possible in a rodent model with the preference for renal excretion notable through comparative fluorescence intensities from the ureters, kidneys and liver. Ureteral identification was also successfully performed in a larger animal porcine model under abdominal surgical conditions. Three tested doses of 0.5, 0.25 and 0.1 mg/kg all successfully identified fluorescent ureters within 20 min of administration which was sustained up to 120 min. 3-D emission heat map imaging allowed the spatial and temporal changes in intensity due to the distinctive peristaltic waves of urine being transferred from the kidneys to the bladder to be identified. As the emission of these fluorophores could be spectrally distinguished from the clinically-used perfusion dye indocyanine green, it is envisaged that their combined use could be a step towards intraoperative colour coding of different tissues.
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Affiliation(s)
- Cathal Caulfield
- Department of Chemistry, Royal College of Surgeons in Ireland (RCSI), D02 PN40 Dublin 2, Ireland
| | - Dan Wu
- Department of Chemistry, Royal College of Surgeons in Ireland (RCSI), D02 PN40 Dublin 2, Ireland
| | - Ian S. Miller
- Precision Cancer Medicine Group, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland (RCSI), D02 PN40 Dublin 2, Ireland
- National Pre-clinical Imaging Centre (NPIC), Royal College of Surgeons in Ireland (RCSI), D02 PN40 Dublin, Ireland
| | - Annette T. Byrne
- Precision Cancer Medicine Group, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland (RCSI), D02 PN40 Dublin 2, Ireland
- National Pre-clinical Imaging Centre (NPIC), Royal College of Surgeons in Ireland (RCSI), D02 PN40 Dublin, Ireland
| | - Pól Mac Aonghusa
- IBM Research-Ireland, Damastown Industrial Estate, Mulhuddart, D02 PN40 Dublin 15, Ireland
| | - Sergiy Zhuk
- IBM Research-Ireland, Damastown Industrial Estate, Mulhuddart, D02 PN40 Dublin 15, Ireland
| | - Lorenzo Cinelli
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, 20132 Milan, Italy
| | - Elisa Bannone
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France
- Department of Surgery, Istituto Fondazione Poliambulanza, 25124 Brescia, Italy
- Department of Pancreatic Surgery, Verona University, 37134 Verona, Italy
| | - Jacques Marescaux
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Sylvain Gioux
- ICube Lab, Photonics Instrumentation for Health, 67400 Strasbourg, France
| | - Michele Diana
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France
- ICube Lab, Photonics Instrumentation for Health, 67400 Strasbourg, France
- Digestive and Endocrine Surgery, Nouvel Hospital Civil, University of Strasbourg, 67000 Strasbourg, France
| | - Taryn L. March
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | | | - Ronan Cahill
- UCD Centre for Precision Surgery, School of Medicine, University College Dublin, D02 PN40 Dublin 4, Ireland
- Department of Surgery, Mater Misericordiae University Hospital, D02 PN40 Dublin 7, Ireland
| | - Donal F. O’Shea
- Department of Chemistry, Royal College of Surgeons in Ireland (RCSI), D02 PN40 Dublin 2, Ireland
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Haruishi M, Matsuoka A, Tate S, Arai T, Ichikawa T, Usui H. Delayed postrenal failure due to progression of asymptomatic hydronephrosis following hysterectomy. J Obstet Gynaecol Res 2023. [PMID: 36792054 DOI: 10.1111/jog.15614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
Asymptomatic hydronephrosis following hysterectomy is generally transient. Here, we present the case of a 52-year-old woman who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for benign indications. Computed tomography (CT) to examine bleeding on the second postoperative day incidentally revealed bilateral grade II hydronephrosis. Asymptomatic hydronephrosis was not reevaluated, and gynecological outpatient follow-up was terminated with a normal creatinine level on postoperative day 43. On postoperative day 107, the patient noticed weight gain of 10 kg, decreased urine output, and generalized edema. The serum creatinine level was elevated to 5.4 mg/dL, and CT revealed bilateral grade III hydronephrosis. Urgent bilateral ureteral stenting was performed to treat stenosis of the distal ureters that caused postrenal failure. Ureteroneocystostomy was performed for strict stenosis of the right ureter at 10 months postoperatively. Histological examination of the resected distal ureter showed inflammation and fibrosis. Asymptomatic hydronephrosis developing after hysterectomy progress to delayed postrenal failure.
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Affiliation(s)
- Mana Haruishi
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ayumu Matsuoka
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shinichi Tate
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Arai
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hirokazu Usui
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
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16
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Foo XY, Nugent R. Implementation of a policy of universal cystoscopy at the time of hysterectomy for benign indications: A retrospective comparative study. Aust N Z J Obstet Gynaecol 2023; 63:99-104. [PMID: 35909245 DOI: 10.1111/ajo.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lower urinary tract injury (LUTI) is a serious complication of major gynaecologic surgery. Although intra-operative cystoscopy can facilitate timely diagnosis and treatment of LUTI, the optimal approach to cystoscopy at the time of benign hysterectomy remains debatable. AIMS To assess whether implementation of a policy of universal cystoscopy at the time of benign hysterectomy was associated with a difference in intra-operative detection and rates of LUTI. MATERIALS AND METHODS Retrospective cohort study at a large regional teaching hospital where a policy of universal cystoscopy at the time of benign hysterectomy was implemented on 30 September 2019. Hysterectomies performed from 1 November 2016 to 31 March 2021 were included and categorised into the 'pre-policy' and 'post-policy' groups. Primary outcomes included the intra-operative detection and overall rates of LUTI. Secondary outcome was the policy adherence rate. Multivariate analysis was used to examine the effect of this policy on the outcomes. RESULTS There were 584 hysterectomies identified, including 325 in the pre-policy group and 259 in the post-policy group. Cystoscopy was performed in 55.1% in the pre-policy group and 97.7% in the post-policy group (P < 0.01). Adjusted for age, indication and route of hysterectomy, there were no significant differences in the intra-operative cystoscopic detection of LUTI (42.9% vs 25.0%, P = 0.55) or the rate of LUTI (2.2% vs 1.5%, P = 0.25) after implementation of the policy. CONCLUSIONS The practice of universal cystoscopy at the time of benign hysterectomy has not been associated with a significant change in the intra-operative detection and rates of LUTI at our institution.
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Affiliation(s)
- Xin Yu Foo
- Women's and Families Services, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Rachael Nugent
- Women's and Families Services, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
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17
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Wei G, Harley F, O’Callaghan M, Adshead J, Hennessey D, Kinnear N. Systematic review of urological injury during caesarean section and hysterectomy. Int Urogynecol J 2023; 34:371-389. [PMID: 36251061 PMCID: PMC9870963 DOI: 10.1007/s00192-022-05339-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/05/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We aim to review iatrogenic bladder and ureteric injuries sustained during caesarean section and hysterectomy. METHODS A search of Cochrane, Embase, Medline and grey literature was performed using methods pre-published on PROSPERO. Eligible studies described iatrogenic bladder or ureter injury rates during caesarean section or hysterectomy. The 15 largest studies were included for each procedure sub-type and meta-analyses performed. The primary outcome was injury incidence. Secondary outcomes were risk factors and preventative measures. RESULTS Ninety-six eligible studies were identified, representing 1,741,894 women. Amongst women undergoing caesarean section, weighted pooled rates of bladder or ureteric injury per 100,000 procedures were 267 or 9 events respectively. Injury rates during hysterectomy varied by approach and pathological condition. Weighted pooled mean rates for bladder injury were 212-997 events per 100,000 procedures for all approaches (open, vaginal, laparoscopic, laparoscopically assisted vaginal and robot assisted) and all pathological conditions (benign, malignant, any), except for open peripartum hysterectomy (6,279 events) and laparoscopic hysterectomy for malignancy (1,553 events). Similarly, weighted pooled mean rates for ureteric injury were 9-577 events per 100,000 procedures for all hysterectomy approaches and pathologies, except for open peripartum hysterectomy (666 events) and laparoscopic hysterectomy for malignancy (814 events). Surgeon inexperience was the prime risk factor for injury, and improved anatomical knowledge the leading preventative strategy. CONCLUSIONS Caesarean section and most types of hysterectomy carry low rates of urological injury. Obstetricians and gynaecologists should counsel the patient for her individual risk of injury, prospectively establish risk factors and implement preventative strategies.
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Affiliation(s)
- Gavin Wei
- grid.410678.c0000 0000 9374 3516Department of Urology, Austin Health, Melbourne, Australia
| | - Frances Harley
- grid.417072.70000 0004 0645 2884Department of Urology, Western Health, Melbourne, Australia
| | - Michael O’Callaghan
- grid.1010.00000 0004 1936 7304Adelaide Medical School, University of Adelaide, Adelaide, Australia ,grid.414925.f0000 0000 9685 0624Urology Unit, Flinders Medical Centre, Bedford Park, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Flinders University, Adelaide, Australia
| | - James Adshead
- grid.415953.f0000 0004 0400 1537Lister Hospital, Stevenage, UK
| | - Derek Hennessey
- grid.411785.e0000 0004 0575 9497Department of Urology, Mercy University Hospital, Cork, Ireland
| | - Ned Kinnear
- grid.410678.c0000 0000 9374 3516Department of Urology, Austin Health, Melbourne, Australia ,grid.1010.00000 0004 1936 7304Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Armas-Phan M, Schmeusser BN, Eyrich NW, Ogan K. Double-J Stent Misplacement in the Inferior Vena Cava and Right Atrium: A Urovascular Nightmare. EUR UROL SUPPL 2022; 46:128-134. [PMID: 36388431 PMCID: PMC9663327 DOI: 10.1016/j.euros.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/13/2022] Open
Abstract
Ureteral injury may occur during abdominopelvic surgery given its anatomic path and proximity to surrounding organs. We present a case in which a patient required ureteral reimplantation following injury during a hysterectomy. The patient underwent a seemingly uncomplicated robotic ureteral reimplantation with ureteral stent placement. However, postoperative imaging demonstrated extension of the stent from the bladder to the right atrium. It appeared that the gonadal vein was reimplanted rather than the ureter. In a combined urology-vascular surgery case, gonadal vein implantation into the bladder was confirmed. Through-and-through access from the right internal jugular vein to the urethra was established. The ureteral stent was removed and the gonadal vein was embolized, with urology follow-up for planning and scheduling of ureteral reimplantation. Vascular involvement by ureteral stents has considerable risks and often requires further surgery. Ureteral injury can occur even in the hands of experienced surgeons and has a considerable impact on patients. Recognizing important anatomy and using operative techniques to differentiate from nearby structures, such as the gonadal vein, may help in preventing ureteral injury and assisting with repair of ureteral injury. Patient summary We describe a case in which a patient had an injury to her ureter, the tube that transports urine from the kidney to the bladder. When trying to repair this, a blood vessel (the gonadal vein) instead of the ureter was accidentally connected to the bladder. We discuss the resulting complications and management, similar cases, and important anatomy concepts and surgical techniques to prevent this type of injury.
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Affiliation(s)
| | - Benjamin N. Schmeusser
- Corresponding author. Department of Urology, Emory University School of Medicine, 1365 Clifton Road NE, Atlanta, GA 30322, USA. Tel. +1 513 9104355.
| | - Nicholas W. Eyrich
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
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Cebeci OÖ. Is endourological intervention a suitable treatment option in the management of iatrogenic thermal ureteral injury? A contemporary case series. BMC Urol 2022; 22:137. [PMID: 36057579 PMCID: PMC9441037 DOI: 10.1186/s12894-022-01094-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iatrogenic ureteral injury (IUI) is relatively rare, however, can cause sepsis, kidney failure, and death. Most cases of IUI are not recognized until the patient presents with symptoms following pelvic surgery or radiotherapy. Recently, minimally invasive approaches have been used more frequently in the treatment of IUI. This study evaluates urological intervention success rates and long-term clinical outcomes according to the type of IUI following hysterectomy. METHODS Twenty-seven patients who underwent surgery due to IUI in our clinic following hysterectomy were evaluated between January 2011 and April 2018. Patients were classified according to the time of diagnosis of IUI. The IUI cases diagnosed within the first 24 h following hysterectomy were designated as "immediate" IUI, while that diagnosed late period was considered 'delayed' IUI. The type of IUI was categorized as "cold transection" if it was due to surgical dissection or ligation without any thermal energy, and "thermal injury" if it was related to any energy-based surgical device. Patient information, laboratory and perioperative data, imaging studies, and complications were assessed retrospectively. RESULTS All cases of delayed diagnosis IUI were secondary to laparoscopic hysterectomy (P = 0.041). Patients with thermal injury to the ureter were mostly diagnosed late (delayed) (P = 0.029). While 31% of the patients who underwent endourological intervention were diagnosed immediately, 69% of them were diagnosed as delayed. These rates were roughly reversed for open reconstructive surgery: 73% and 27% (P = 0.041), respectively. We detected eight ureteral complications in our patient cohort following the urological intervention. In all these failed cases, the cause of IUI was a thermal injury (P = 0.046) and the patients had received endourological treatment (P = 0.005). No complications were detected in patients who undergo open urological reconstructive surgery. While one of the patients who developed urological complications had an immediate diagnosis, seven were in the delayed group (P = 0.016). CONCLUSION Endourological intervention is performed more frequently in delayed diagnosed IUI following hysterectomy, however, the treatment success rate is low if thermal damage has developed in the ureter. Surgical reconstruction is should be preferred in these thermal injury cases to avoid further ureter-related complications.
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Affiliation(s)
- Oğuz Özden Cebeci
- Department of Urology, Kocaeli Derince Traning and Research Hospital, Saglik Bilimleri University, Ibni Sina Blv 1, 41200, Derince, Kocaeli, Turkey.
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Binder S, Boosz A, Kolioulis I, Baev E, Müller N, Krämer J, Müller A. Detection rate with routine postoperative renal ultrasound to identify urinary tract injury after gynecological surgery. Arch Gynecol Obstet 2022; 306:1617-1621. [PMID: 35916959 DOI: 10.1007/s00404-022-06714-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/17/2022] [Indexed: 11/02/2022]
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.
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Affiliation(s)
- Simon Binder
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany. .,Department of Gynecology and Obstetrics, Diakonissenkrankenhaus Karlsruhe, Diakonissenstraße 28, 76199, Karlsruhe, Germany.
| | - Alexander Boosz
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Ioannis Kolioulis
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Evgeni Baev
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Nadine Müller
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Janine Krämer
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Andreas Müller
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
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21
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Sheyn D, Gupta A, Boyd S, Wu X, Shoag J, Bretschneider CE. Incidence and Risk Factors for Genitourinary Tract Injury Within 1 Year After Surgery for Pelvic Organ Prolapse. UROGYNECOLOGY (PHILADELPHIA, PA.) 2022; 28:506-517. [PMID: 36256964 DOI: 10.1097/spv.0000000000001201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
IMPORTANCE The rate of genitourinary tract injury (GUTI) following pelvic organ prolapse (POP) surgery is presently ill-defined and based on relatively small trials with short follow-up time. Given the potential for higher risk of injury with POP, a better understanding of this type of injury is important for patient counseling. OBJECTIVES The objective of this study was to identify the incidence and risk factors of GUTI related to POP surgery. STUDY DESIGN Women undergoing POP surgery between 2010 and 2019 were identified using Current Procedural Terminology codes in the Premier Healthcare Database. The primary outcome was GUTI, defined as bladder or ureteral injury, and vesicovaginal or ureterovaginal fistula within 1 year of surgery. Genitourinary tract injury was identified using International Classification of Diseases and Current Procedural Terminology codes. Patients were divided into those with and without GUTI. Differences between groups were evaluated using the Student t test, Wilcoxon rank-sum test, and Fisher exact test as appropriate. Multivariable logistic regression was used to evaluate the independent predictors of GUTI. RESULTS One hundred thirty-nine thousand one hundred fifty-eight surgical procedures for POP were captured between 2010 and 2019. The rate of GUTI was 1.10%: 0.48% bladder, 0.64% ureteral injuries, and 0.01% fistulas. The most significant variables associated with any GUTI were as follows: adhesiolysis (adjusted odds ratio [aOR], 2.64; 95% confidence interval [CI], 1.07-6.51), blood transfusion (aOR, 3.67; 95% CI, 1.34-10.04), and low-volume surgeons (<12 cases per year) (aOR, 1.68; 95% CI, 1.60-1.77), nonurologic or gynecologic surgeon specialty (aOR, 1.62; 95% CI, 1.49-2.00), and uterosacral suspension (aOR, 1.30; 95% CI, 1.13-1.49). CONCLUSIONS The rate of GUTI following POP surgery is lower than has previously been reported. Surgeon experience and specialty and surgical approach may affect GUTI incidence.
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Affiliation(s)
- David Sheyn
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Ankita Gupta
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Louisville Health, Louisville, KY
| | - Sara Boyd
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Penn State Health, Hershey, PA
| | - Xian Wu
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
| | | | - C Emi Bretschneider
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
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22
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Very Low Rates of Ureteral Injury in Laparoscopic Hysterectomy Performed by Fellowship-Trained Minimally Invasive Gynecologic Surgeons. J Minim Invasive Gynecol 2022; 29:1099-1103. [PMID: 35691546 DOI: 10.1016/j.jmig.2022.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE The objective of this case series is to evaluate the rates of ureteral injury at the time of laparoscopic hysterectomy among high-volume fellowship-trained surgeons. DESIGN A retrospective chart review was performed, evaluating laparoscopic hysterectomy cases between 2009-2019 performed exclusively by fellowship-trained surgeons. SETTING Division of Minimally Invasive Gynecologic Surgery (MIGS) at the Brigham & Women's Hospital and Brigham & Women's Faulkner Hospital, a Harvard Medical School teaching hospital in Boston. PATIENTS All patients undergoing laparoscopic hysterectomy by one of five surgeons with fellowship training in Minimally Invasive Gynecologic Surgery (MIGS). INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS: A total of 5,160 cases were performed by MIGS surgeons between 2009-2019 at our institution. Out of these cases, 2,345 were laparoscopic hysterectomy cases with available intraoperative and postoperative documentation. Most patients had prior surgeries and the most common indications for hysterectomy included uterine fibroids, pelvic pain/endometriosis, and abnormal uterine bleeding. At the time of hysterectomy, 1 ureteral injury (0.04%) was noted. No additional delayed ureteral injuries were observed. The majority of patients were discharged home the same day (64.9%) and did not have any postoperative complications (63.9%) as designated by the Clavien-Dindo classification. CONCLUSION Ureteral injury, while rare, is more prevalent in gynecologic surgery as compared to other surgical disciplines that have some focus in the pelvis. No study to date has evaluated the effect of surgical training and volume on rates of ureteral injuries. This study retrospectively examined ureteral injury rates for one group of high-volume fellowship-trained surgeons and found their rates to be lower than the national average. Proposals are presented for optimizing training and delivery of gynecologic surgical care to minimize complications.
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23
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Propst K, Yao M, Ridgeway B. Prophylactic Ureteral Catheter Placement to Prevent Urinary Tract Injury at the Time of Hysterectomy. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Katie Propst
- Urogynecology and Reconstructive Pelvic Surgery, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Meng Yao
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Beri Ridgeway
- Urogynecology and Reconstructive Pelvic Surgery, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
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24
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Kapetanos K, Light A, Thakare N, Mahbubani K, Saeb-Parsy K, Saeb-Parsy K. Bioengineering solutions for Ureteric disorders: Clinical need, challenges and opportunities. BJU Int 2022; 130:408-419. [PMID: 35388587 PMCID: PMC9544734 DOI: 10.1111/bju.15741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/26/2022] [Accepted: 03/28/2022] [Indexed: 12/01/2022]
Abstract
Objectives To summarise the causes of ureteric damage and the current standard of care, discussing the risks and benefits of available therapeutic options. We then focus on the current and future solutions that can be provided by ureteric bioengineering and provide a description of the ideal characteristics of a bioengineered product. Methods We performed a literature search in February 2021 in: Google Scholar, Medline, and Web of Science. Three searches were conducted, investigating: (a) the epidemiology of ureteric pathology, (b) the current standard of care, and (c) the state of the art in ureteric bioengineering. Results The most‐common causes of ureteric damage are iatrogenic injury and external trauma. Current approaches to treatment include stent placement or surgical reconstruction. Reconstruction can be done using either urological tissue or segments of the gastrointestinal tract. Limitations include scarring, strictures, and infections. Several bioengineered alternatives have been explored in animal studies, with variations in the choice of scaffold material, cellular seeding populations, and pre‐implantation processing. Natural grafts and hybrid material appear to be associated with superior outcomes. Furthermore, seeding of the scaffold material with stem cells or differentiated urothelial cells allows for better function compared to acellular scaffolds. Some studies have attempted to pre‐implant the graft in the omentum prior to reconstruction, but this has yet to prove any definitive benefits. Conclusion There is an unmet clinical need for safer and more effective treatment for ureteric injuries. Urological bioengineering is a promising solution in preclinical studies. However, substantial scientific, logistic, and economic challenges must be addressed to harness its transformative potential in improving outcomes.
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Affiliation(s)
| | - Alexander Light
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Niyukta Thakare
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Krishnaa Mahbubani
- Cambridge Biorepository for Translational Medicine (CBTM), NIHR Cambridge Biomedical Research Centre, Cambridge, UK.,Department of Haematology, University of Cambridge, Cambridge, UK
| | - Kasra Saeb-Parsy
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kourosh Saeb-Parsy
- Department of Surgery, University of Cambridge and Cambridge NIHR Biomedical Research Centre, Cambridge
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25
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Wang M, Wang D, Zuo J, Liu T, Niu Z, Xie J, Qi D. A Dose-Response Relationship Study of Prophylactic Nalbuphine to Reduce Pain During the Awakening Period in Patients Undergoing Laparoscopic Total Hysterectomy: A Randomized, Controlled, Double-Blind Clinical Study. Drug Des Devel Ther 2022; 16:981-990. [PMID: 35386854 PMCID: PMC8979566 DOI: 10.2147/dddt.s356582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/19/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Min Wang
- Department of Anesthesiology, Jinshan Hospital of Fudan University, Shanghai, People’s Republic of China
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Dongyue Wang
- Department of Anesthesiology, Jinshan Hospital of Fudan University, Shanghai, People’s Republic of China
| | - Jingzhi Zuo
- Emergency Department, Yichang Central People’s Hospital, Yichang, Hubei, People’s Republic of China
| | - Tianyu Liu
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Zheng Niu
- Department of Anesthesiology, Zhangjiagang First People’s Hospital, Zhangjiagang, Jiangsu, People’s Republic of China
| | - Juan Xie
- Department of Anesthesiology, Jinshan Hospital of Fudan University, Shanghai, People’s Republic of China
| | - Dunyi Qi
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Correspondence: Dunyi Qi, Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China, Email
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26
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Welch EK, Dengler KL, Guirguis M, Strauchon C, Olsen C, Von Pechmann W. Risk factors of lower urinary tract injury with laparoscopic sacrocolpopexy. AJOG GLOBAL REPORTS 2022; 2:100035. [DOI: 10.1016/j.xagr.2021.100035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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27
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Tanaka Y, Higami S, Terada M, Hosoi A, Koyama S, Shiki Y. Perioperative serum creatinine change and delayed urologic complications following total laparoscopic hysterectomy for benign indications. Gynecol Minim Invasive Ther 2022; 11:88-93. [PMID: 35746914 PMCID: PMC9212181 DOI: 10.4103/gmit.gmit_142_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/06/2021] [Accepted: 06/02/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives: The objective of the study was to investigate the association between perioperative serum creatinine change and delayed urologic complications following total laparoscopic hysterectomy (TLH) for benign indications. Materials and Methods: A total of 510 cases (503 cases without delayed urologic injuries and 7 cases with delayed urologic injuries) in which TLH was performed for benign indications were retrospectively reviewed. The patient characteristics and surgical outcomes were compared between patients with and without delayed urologic injuries. Laboratory markers (serum creatinine level at the preoperative and postoperative periods, white blood cell [WBC] ratio, and C-reactive protein [CRP] ratio) were analyzed to evaluate the diagnostic value of these laboratory markers. Results: There were no statistically significant differences in age, parity, body mass index, the presence of diabetes mellitus, preoperative GnRH agonist use, previous history of abdominal surgery or the performance of adnexal surgery, ASRM score, the presence of cul-de-sac obliteration, operative time, blood loss or weight of the resected specimens between the two groups. The proportions of patients who showed an elevated creatinine level on postoperative day 1 was significantly higher in the delayed urologic injury group (9.9% vs. 57%, P < 0.001). The combination of the three laboratory markers yielded an area under the ROC curve value of 0.75 (95% confidence interval, 0.491–1) in the detection of delayed urologic injuries. Conclusion: A change in the serum creatine level over baseline after surgery may indicate the possibility of urologic injuries. The combination of creatinine change and other factors, such as WBC or CRP would be helpful for detecting urologic complications after TLH.
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28
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Halinski A, Halinski A, Halinski P. Olbert's Balloon Dilatation as a Minimally Invasive Possibility of Treating Ureteral Stricture After Complicated URS-L in Children. Front Pediatr 2022; 10:767500. [PMID: 36105858 PMCID: PMC9465309 DOI: 10.3389/fped.2022.767500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 05/30/2022] [Indexed: 11/22/2022] Open
Abstract
Olbert's balloon dilatation is a surgical technique used for the treatment of ureteral stricture. Although it is more frequently used in adults, due to the advancing miniaturization of the equipment, this technique has become possible in children. We would like to present five cases of Olbert's balloon dilatation carried out in children with ureteral stricture, aged 12-17 years. All of these children were diagnosed for at least 6 months. Ureteral stricture has been noticed in those patients with a time of a stone residence in the ureter longer than 6 months. The duration of the stone in the ureter varied from 6 to 18 months. The symptoms were abdominal pain, renal colic pain, UTI, fever, vomiting, and nausea. Ultrasound (US) revealed hydronephrosis and ureter dilatation above the stone. All of these children had grade-3 hydronephrosis based on the Onen grading system during admission to the hospital. The lack of renal function on the DMSA scan was observed with an average of 22%. JJ-stent was inserted as a first-line treatment. A retrograde pyelogram revealed ureteral stricture at a length from 1 to 1.7 cm in the place where the stone was ingrown. Olbert's balloon dilatation under fluoroscopy was performed successfully in all children. We achieved an efficacy of 60% in our series. Renal function increased to an average of 36% on DMSA 3 months after surgery. The level of creatinine is shaped at an average of 0.6. On US, two children had no hydronephrosis while one child had grade-1 hydronephrosis. The longest follow-up is now 4 years, with the same good results. In conclusion, Olbert's balloon dilatation is an effective, safe, and minimally invasive tool for ureteral stricture in the hands of the endourological experienced pediatric urologist. But more prospective, randomized trials are still needed.
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Affiliation(s)
- Adam Halinski
- Department of Pediatric Urology, Private Medical Center "Klinika Wisniowa", Zielona Góra, Poland.,Department of Clinical Genetics and Pathology, University of Zielona Gora, Zielona Gora, Poland.,Scientific Office, U-merge Ltd., London-Athens-Dubai, Athens, Greece
| | - Andrzej Halinski
- Department of Pediatric Urology, Private Medical Center "Klinika Wisniowa", Zielona Góra, Poland
| | - Paweł Halinski
- Department of Pediatric Urology, Private Medical Center "Klinika Wisniowa", Zielona Góra, Poland
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29
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Wiacek A, Wang KC, Wu H, Bell MAL. Photoacoustic-Guided Laparoscopic and Open Hysterectomy Procedures Demonstrated With Human Cadavers. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:3279-3292. [PMID: 34018931 DOI: 10.1109/tmi.2021.3082555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Hysterectomy (i.e., surgical removal of the uterus) requires severing the main blood supply to the uterus (i.e., the uterine arteries) while preserving the nearby, often overlapping, ureters. In this paper, we investigate dual-wavelength and audiovisual photoacoustic imaging-based approaches to visualize and differentiate the ureter from the uterine artery and to provide the real-time information needed to avoid accidental ureteral injuries during hysterectomies. Dual-wavelength 690/750 nm photoacoustic imaging was implemented during laparoscopic and open hysterectomies performed on human cadavers, with a custom display approach designed to visualize the ureter and uterine artery. The proximity of the surgical tool to the ureter was calculated and conveyed by tracking the surgical tool in photoacoustic images and mapping distance to auditory signals. The dual-wavelength display showed up to 10 dB contrast differences between the ureter and uterine artery at three separation distances (i.e., 4 mm, 5 mm, and 6 mm) during the open hysterectomy. During the laparoscopic hysterectomy, the ureter and uterine artery were visualized in the dual-wavelength image with up to 24 dB contrast differences. Distances between the ureter and the surgical tool ranged from 2.47 to 7.31 mm. These results are promising for the introduction of dual-wavelength photoacoustic imaging to differentiate the ureter from the uterine artery, estimate the position of the ureter relative to a surgical tool tip, map photoacoustic-based distance measurements to auditory signals, and ultimately guide hysterectomy procedures to reduce the risk of accidental ureteral injuries.
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30
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Long JA, Savoie PH, Boissier R. [Management of complications of upper urinary tract trauma (kidney and ureter)]. Prog Urol 2021; 31:1014-1021. [PMID: 34814985 DOI: 10.1016/j.purol.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Complications of kidney and ureter trauma are directly in the field of the urologist. If they have a second place in the vital prognosis, a good knowledge of these pathologies is essential. METHODS A systematic review of the literature was carried out using the Medline database in order to identify the most relevant articles in English and French. RESULTS Urinary extravasation in the context of blunt kidney trauma has a good functional prognosis. Impaired function of the traumatized kidney is linked to vascular damage associated with grade IV and V. Non operative management is the treatment of choice with deferred management in the event of septic or painful deterioration. The lesions of the ureter are predominantly iatrogenic. While incomplete lesions can be treated endoscopically, complete lesions (stenosis or wound) require surgery. The most frequent lesions, in the distal ureter are easily treated by ureterovesical reimplantation. Large losses of substance may require ileal replacement. CONCLUSION Blunt kidney trauma causing urinary extravasation, with an excellent prognosis, are treated conservatively. Conversely, lesions of the ureter require in the majority of cases an intervention to restore continuity.
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Affiliation(s)
- J-A Long
- Centre hospitalier universitaire de Grenoble, 38043 Grenoble cedex 9, France; TIMC-IMAG, CNRS 5525, La Tronche cedex 9, France.
| | - P-H Savoie
- Hôpital d'instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - R Boissier
- CHU de La Conception, AP-HM, 13005 Marseille, France
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31
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Ravlo M, Moen MH, Bukholm IRK, Lieng M, Vanky E. Ureteric injuries during hysterectomy-A Norwegian retrospective study of occurrence and claims for compensation over an 11-year period. Acta Obstet Gynecol Scand 2021; 101:68-76. [PMID: 34766333 DOI: 10.1111/aogs.14293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Ureteric injury is a rare but serious, iatrogenic complication of hysterectomy. The risk depends on indication for surgery, predisposing risk factors, and peroperative conditions. Our aims were to evaluate and learn from compensation claims to The Norwegian System of Patient Injury Compensation (NPE) for ureteric injury occurring during hysterectomies to predict risk factors, time of identification, symptoms, and consequences, and to relate these cases to injuries registered in The Norwegian Patient Registry. MATERIAL AND METHODS A retrospective study of ureteric injuries occurring during hysterectomies, reported to NPE and the Norwegian Patient Registry from 2009 through 2019. RESULTS During the study period, 53 096 hysterectomies were registered in The Norwegian Patient Registry, of which ureteric injury was documented in 643 (1.2%). More ureteric injuries were registered in large hospital trusts than in small trusts (1.3% vs. 0.7%, p < 0.05). NPE received 69 claims due to ureteric injury occurring during hysterectomy, comprising 11% of all injuries in the study period. Compensation was approved for 15%. Women who claimed compensation were younger (48.1 ± 8.9 years vs. 55.1 ± 13.6 years, p < 0.01), more likely to have had a benign diagnosis (89.9% vs. 52.1%, p < 0.01), and more likely to have had the ureteric injury recognized after discharge (58.0% vs. 33.0%, p < 0.001) compared with non-complainants. Identification of the ureters during the hysterectomy was documented in 30% of the NPE patient files. Additional information for the NPE cases included the following. The most common symptoms of unidentified injury were pain (77%), fever (12%), urinary leakage (13%), and anuria (8%). Re-operation was necessary in 77% of the cases, and 10% of the women lost one kidney. Long-term consequences after repair, such as loss of a kidney or persistent pain, were seen in 17%. No women died because of the injury. CONCLUSIONS The incidence of ureteric injury occurring during hysterectomy in Norway was 1.2%; 11% involved a claim for compensation, and 15% of these had their case approved. Most ureteric injuries were not recognized during the hysterectomy. Documentation of peroperative identification of the ureters during hysterectomy was often missing. Vigilance to pain as a postoperative symptom of peroperative unrecognized ureteric injury may result in earlier diagnosis and treatment.
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Affiliation(s)
- Merethe Ravlo
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynecology, St. Olav's Hospital, University Hospital of Trondheim, Norway
| | - Mette Haase Moen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Marit Lieng
- Division of Gynecology and Obstetrics, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynecology, St. Olav's Hospital, University Hospital of Trondheim, Norway
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32
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Nayak AL, Breau R, Hickling D, Pascali D, Clancy A, Mallick R, Chen I. Risk Factors for Urologic Injury in Women Undergoing Hysterectomy for Benign Indication. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:247-254. [PMID: 34648958 DOI: 10.1016/j.jogc.2021.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate risk factors associated with urologic injury in women undergoing hysterectomy for benign indication. METHODS A retrospective cohort study for the period of 2011-2018 was conducted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Women without urologic injury were compared with women with injury. A pre-specified multivariable logistic regression model, controlling for key patient demographic factors and intraoperative variables, was used to assess for surgical factors associated with urologic injury. RESULTS Among 262 117 women who underwent hysterectomy for benign indication, 1539 (0.6%) sustained urologic injury. On average, patients with urologic injury were younger, had lower body mass index (BMI), and more frequently underwent a transabdominal surgical approach. Patients who underwent total hysterectomy had increased odds of urologic injury than those who underwent subtotal hysterectomy (adjusted OR [aOR] 1.49; 95% confidence interval [CI] 1.21-1.84). Patients with class III obesity had lower odds of injury than patients with normal BMI (aOR 0.64; 95% CI 0.51-0.80). For risk of urologic injury, an interaction was observed between surgical approach and surgical indication. Abdominal compared with laparoscopic approach was associated with urologic injury for women with endometriosis (aOR 2.98; 95% CI 1.99-4.47), pelvic pain (aOR 3.51; 95% CI 1.74-7.08), menstrual disorders (aOR 4.33; 95% CI 1.68-11.1), and fibroids (aOR 2.28; 95% CI 1.72-3.03). Vaginal compared with laparoscopic approach was associated with increased odds of injury for women with menstrual disorders (aOR 7.62; 95% CI 1.37-42.5). CONCLUSION While the risk of urologic injury during hysterectomy for benign indication is low, the risk is dependent on patient disease factors and surgical approach.
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Affiliation(s)
| | - Rodney Breau
- Faculty of Medicine, University of Ottawa, Ottawa, ON; The Ottawa Hospital Research Institute, Ottawa, ON; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON
| | - Duane Hickling
- Faculty of Medicine, University of Ottawa, Ottawa, ON; The Ottawa Hospital Research Institute, Ottawa, ON; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON
| | - Dante Pascali
- Faculty of Medicine, University of Ottawa, Ottawa, ON; Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, ON
| | - Aisling Clancy
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, ON
| | | | - Innie Chen
- The Ottawa Hospital Research Institute, Ottawa, ON; Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, ON.
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Gundogdu G, Okhunov Z, Cristofaro V, Starek S, Veneri F, Orabi H, Jiang P, Sullivan MP, Mauney JR. Evaluation of Bi-Layer Silk Fibroin Grafts for Tubular Ureteroplasty in a Porcine Defect Model. Front Bioeng Biotechnol 2021; 9:723559. [PMID: 34604185 PMCID: PMC8484785 DOI: 10.3389/fbioe.2021.723559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/31/2021] [Indexed: 02/05/2023] Open
Abstract
Ureteral reconstruction with autologous tissue grafts is often limited by tissue availability and donor site morbidity. This study investigates the performance of acellular, bi-layer silk fibroin (BLSF) scaffolds in a porcine model of ureteroplasty. Tubular ureteroplasty with BLSF grafts in combination with transient stenting for 8 weeks was performed in adult female, Yucatan, mini-swine (N = 5). Animals were maintained for 12 weeks post-op with imaging of neoconduits using ultrasonography and retrograde ureteropyelography carried out at 2 and 4 weeks intervals. End-point analyses of ureteral neotissues and unoperated controls included histological, immunohistochemical (IHC), histomorphometric evaluations as well as ex vivo functional assessments of contraction/relaxation. All animals survived until scheduled euthanasia and displayed mild hydronephrosis (Grades 1-2) in reconstructed collecting systems during the 8 weeks stenting period with one animal presenting with a persistent subcutaneous fistula at 2 weeks post-op. By 12 weeks of scaffold implantation, unstented neoconduits led to severe hydronephrosis (Grade 4) and stricture formation in the interior of graft sites in 80% of swine. Bulk scaffold extrusion into the distal ureter was also apparent in 60% of swine contributing to ureteral obstruction. However, histological and IHC analyses revealed the formation of innervated, vascularized neotissues with a-smooth muscle actin+ and SM22α+ smooth muscle bundles as well as uroplakin 3A+ and pan-cytokeratin + urothelium. Ex vivo contractility and relaxation responses of neotissues were similar to unoperated control segments. BLSF biomaterials represent emerging platforms for tubular ureteroplasty, however further optimization is needed to improve in vivo degradation kinetics and mitigate stricture formation.
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Affiliation(s)
- Gokhan Gundogdu
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Vivian Cristofaro
- Division of Urology, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Stephanie Starek
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Faith Veneri
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Hazem Orabi
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Pengbo Jiang
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Maryrose P. Sullivan
- Division of Urology, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Joshua R. Mauney
- Department of Urology, University of California, Irvine, Irvine, CA, United States
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
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Mansour Ghanaie M, Asgari SA, Haghbin A, Mehdizade F, Asgari Ghalebin SM. Post-Hysterectomy Transient Hydronephrosis: A Prospective Study. J Family Reprod Health 2021; 15:13-18. [PMID: 34429732 PMCID: PMC8346738 DOI: 10.18502/jfrh.v15i1.6068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To determine the incidence and importance of transient asymptomatic hydronephrosis following total hysterectomy. Materials and methods: In a prospective study over 4 year, 368 women were studied who had undergone a total abdominal or vaginal hysterectomy. Totally, 95% of operations were done for benign diseases (abnormal uterine bleeding, chronic pelvic pain, uterine prolapse, etc.) and 5% were performed for uterine malignancy. Renal ultrasonography was performed before and 3, 7 and 28 days after the surgery for diagnosing hydronephrosis. Intravenous urography was performed in patients with either persistent/progressive or symptomatic hydronephrosis. Results: There was no intraoperative identifiable ureteral injury. Hydronephrosis was seen in 35 (9.5%), 21 (5.7%), and 1 (0.27%) patients at days 3, 7 and 28 after the operation, respectively. The degree of hydronephrosis was graded I, II or III. Considering the frequency and severity of hydronephrosis, the right kidney was affected more. Hydronephrosis correlated significantly with indication, duration and route of surgery as well as patient's age. All kidneys improved spontaneously, except one case which needed ureteral stenting with no surgical intervention (p=0.05). Conclusion: Transient hydronephrosis could occur after simple total hysterectomy despite the absence of any obvious intraoperative ureteral injury. It is noted in 9.5% of the patients within three days after the non-complicated surgery. The clinical course may be continued until one month.
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Affiliation(s)
- Mandana Mansour Ghanaie
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Alzahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyed Alaedin Asgari
- Department of Urology, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Azar Haghbin
- Guilan University of Medical Sciences, Rasht, Iran
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Wiacek A, Lediju Bell MA. Photoacoustic-guided surgery from head to toe [Invited]. BIOMEDICAL OPTICS EXPRESS 2021; 12:2079-2117. [PMID: 33996218 PMCID: PMC8086464 DOI: 10.1364/boe.417984] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 05/04/2023]
Abstract
Photoacoustic imaging-the combination of optics and acoustics to visualize differences in optical absorption - has recently demonstrated strong viability as a promising method to provide critical guidance of multiple surgeries and procedures. Benefits include its potential to assist with tumor resection, identify hemorrhaged and ablated tissue, visualize metal implants (e.g., needle tips, tool tips, brachytherapy seeds), track catheter tips, and avoid accidental injury to critical subsurface anatomy (e.g., major vessels and nerves hidden by tissue during surgery). These benefits are significant because they reduce surgical error, associated surgery-related complications (e.g., cancer recurrence, paralysis, excessive bleeding), and accidental patient death in the operating room. This invited review covers multiple aspects of the use of photoacoustic imaging to guide both surgical and related non-surgical interventions. Applicable organ systems span structures within the head to contents of the toes, with an eye toward surgical and interventional translation for the benefit of patients and for use in operating rooms and interventional suites worldwide. We additionally include a critical discussion of complete systems and tools needed to maximize the success of surgical and interventional applications of photoacoustic-based technology, spanning light delivery, acoustic detection, and robotic methods. Multiple enabling hardware and software integration components are also discussed, concluding with a summary and future outlook based on the current state of technological developments, recent achievements, and possible new directions.
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Affiliation(s)
- Alycen Wiacek
- Department of Electrical and Computer Engineering, 3400 N. Charles St., Johns Hopkins University, Baltimore, MD 21218, USA
| | - Muyinatu A. Lediju Bell
- Department of Electrical and Computer Engineering, 3400 N. Charles St., Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Biomedical Engineering, 3400 N. Charles St., Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Computer Science, 3400 N. Charles St., Johns Hopkins University, Baltimore, MD 21218, USA
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Kovachev SM, Kovachev MS. The role of perioperative ureteral stenting for urologic complications in radical surgery of cervical cancer. Urologia 2021; 88:348-354. [PMID: 33719774 DOI: 10.1177/03915603211001178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION This study aimed to establish the urologic complications of radical type C2 hysterectomy in cervical cancer patients with or without ureteral stenting. METHODS This prospective randomized study included 76 (100%) patients with clinically and pathologically established cervical cancer stages I and II treated with radical type C2 hysterectomy with pelvic lymph node dissection for the last 5 years (2014-2019). Patients were randomized into two groups (2:1 ratio): group II received perioperative ureteral stenting (n = 24, 31.6%) and group I did not (n = 52, 68.4%). Urologic complications observed during follow-up include intraoperative ureter and urinary bladder lesions and postoperative ureterovaginal and vesicovaginal fistulas. RESULTS Of the 52 patients in group I who underwent surgery for cervical cancer, urologic complications were observed in 8 (10.5%) patients, 2 (2.6%) of whom underwent preoperative radiation therapy. In group II, urologic complications were observed in 2 (2.6%) patients, of which 1 (1.3%) received preoperative radiation therapy. Intraoperative urologic complications in group I (6.6%) included 3 (3.9%) ureteral lesions cases and 2 (2.6%) cases of urinary bladder lesions, wherein 1 patient received preoperative radiation therapy. One case of (1.3%) urinary bladder lesion was observed in group II. Postoperative complications were observed in 3 patients (3.9%) in group I, including 2 (2.6%) ureterovaginal fistula cases, wherein 1 (1.3%) patient received preoperative radiation therapy, and 1 (1.3%) case of vesicovaginal fistula. In group II, 1 (1.3%) patient who received perioperative radiotherapy developed postoperative vesicovaginal fistula. DISCUSSION Urologic complications are extremely common during and after radical surgery (hysterectomy type C2) for cervical cancer. The cervical cancer stage had a significant effect on intra- and postoperative urologic complication rates in this study; however, no such effect was observed for preoperative radiation therapy and ureteral stenting, and significant differences were observed between the two study groups.
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Barberio M, Al-Taher M, Felli E, Ashoka AH, Marescaux J, Klymchenko A, Diana M. Intraoperative ureter identification with a novel fluorescent catheter. Sci Rep 2021; 11:4501. [PMID: 33627768 PMCID: PMC7904916 DOI: 10.1038/s41598-021-84121-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/12/2021] [Indexed: 12/16/2022] Open
Abstract
Iatrogenic ureteral injuries (IUI) occur in 0.5-1.3% of cases during abdominal surgery. If not recognized intraoperatively, IUI increase morbidity/mortality. A universally accepted method to prevent IUI is lacking. Near-infrared fluorescent imaging (NIRF), penetrating deeper than normal light within the tissue, might be useful, therefore ureter visualization combining NIRF with special dyes (i.e. IRDye 800BK) is promising. Aim of this work is to evaluate the detection of ureters using stents coated with a novel biocompatible fluorescent material (NICE: near-infrared coating of equipment), during laparoscopy. female pigs underwent placement of NICE-coated stents (NS). NIRF was performed, and fluorescence intensity (FI) was computed. Successively, 0.15 mg/kg of IRDye 800BK was administered intravenously, and FI was computed at different timepoints. Ureter visualization using NS only was further assessed in a human cadaver. Both methods allowed in vivo ureter visualization, with equal FI. However, NS were constantly visible whereas IRDye 800BK allowed visualization exclusively during the ureteral peristaltic phases. In the human cadaver, NS provided excellent ureter visualization in its natural anatomical position. NS provided continuous ureteral visualization with similar FI as the IRDye 800BK, which exclusively allowed intermittent visualization, dependent on ureteral peristalsis. NS might prove useful to visualize ureters intraoperatively, potentially preventing IUI.
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Affiliation(s)
- Manuel Barberio
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg, France.
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France.
- Ospedale Cardinale G. Panico, Tricase (LE), Italy.
| | - Mahdi Al-Taher
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Eric Felli
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Anila Hoskere Ashoka
- Laboratoire de Bio-Imagerie et Pathologies, UMR 7021, CNRS, Université de Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
| | - Andrey Klymchenko
- Laboratoire de Bio-Imagerie et Pathologies, UMR 7021, CNRS, Université de Strasbourg, Strasbourg, France
| | - Michele Diana
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
- iCube Laboratory, Photonics for Health, Strasbourg, France
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Vorobev V, Beloborodov V, Golub I, Frolov A, Kelchevskaya E, Tsoktoev D, Maksikova T. Urinary System Iatrogenic Injuries: Problem Review. Urol Int 2021; 105:460-469. [PMID: 33535218 DOI: 10.1159/000512882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION From May to December 2019, a literature review of the urinary system iatrogenic injury problem was performed. The most cited, representative articles in PubMed, Scopus, and WoS databases dedicated to this problem were selected. Urinary system iatrogenic injuries include ureter, bladder, urethra, and kidney traumas. It is widely thought that the main causes of such injuries are urological, obstetric, gynecological, and surgical operations on the retroperitoneal space, pelvis, or perineum. METHODS The purpose of the study is to describe all aspects of the iatrogenic injure problem, under the established scheme and for each of the most damaged organs: the urethra, bladder, kidney, and ureter. The treatment of confirmed iatrogenic injuries largely depends on the period of its detection. Modern medical procedures provide conservative or minimally invasive treatment. An untimely diagnosis worsens the treatment prognosis. "Overlooked" urinary system trauma is a serious threat to society and a particular patient. Thus, incorrect or traumatic catheterization can lead to infection (RR 95%) and urethral stricture (RR ≥11-36%), and percutaneous puncture nephrostomy can cause the risk of functional renal parenchyma loss (median 5%), urinary congestion (7%), or sepsis (0.6-1.5%). RESULTS Lost gain, profits, long-term and expensive, possibly multistage treatment, stress and depression, and the risks of suicide put a heavy financial, moral, and ethical burden on a person and society. Also, iatrogenic injury might have legal consequences. DISCUSSION/CONCLUSION Thus, the significant problem of urinary tract iatrogenic injuries is still difficult to solve. There is a need to implement mandatory examining algorithms for patients at risk, as well as the multidisciplinary principle for all pelvic surgery.
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Affiliation(s)
- Vladimir Vorobev
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation,
| | - Vladimir Beloborodov
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Igor Golub
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Aleksandr Frolov
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Elena Kelchevskaya
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Darizhab Tsoktoev
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Tatyana Maksikova
- Department of Propedeutics of Internal Diseases, Irkutsk State Medical University, Irkutsk, Russian Federation
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Chang OH, Tewari S, Sun JY, Ferrando CA. Risk factors for ureteral obstruction and the diagnostic value of the "cysto-under-tension" technique at the time of uterosacral colpopexy. Int Urogynecol J 2021; 32:2985-2992. [PMID: 33449125 DOI: 10.1007/s00192-020-04650-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective is to determine the incidence of ureteral obstruction and delayed ureteral injury and to identify risk factors for ureteral obstruction following uterosacral colpopexy. The secondary objective is to evaluate the diagnostic value of the "cysto-under-tension" technique, when a cystoscopy is performed prior to vaginal cuff closure with the uterosacral sutures on tension. METHODS This was a retrospective review of patients undergoing uterosacral ligament colpopexy between 2007 and 2012 with a nested case-control analysis. Patients with documented ureteral obstruction on cystoscopy or a delayed ureteral injury were identified. Cases were defined as patients with a ureteral obstruction on cystoscopy and controls as those who did not; a multivariable regression analysis was performed. RESULTS A total of 551 patients underwent uterosacral ligament colpopexy. Twenty-four (4.3% [95% CI = 2.94-6.40]) patients had a ureteral obstruction on cystoscopy, and two (0.4% [95% CI = 0.09-1.31]) patients experienced a delayed ureteral injury. The "cysto-under-tension" technique was used in 40 (7.3%) cases, with a sensitivity of 50.0% (CI = 1.26-98.74) and specificity of 97.4% (CI = 86.2-99.9) to detect ureteral obstruction. On logistic regression for the case-control analysis, increased age remained associated with increased odds of ureteral obstruction (adjOR 1.06, 95% CI = 1.02-1.11) and a higher BMI had lower odds (adjOR 0.89, 95% CI = 0.79-0.98). CONCLUSIONS In this large cohort study, older age was associated with higher odds of obstruction at the time of colpopexy while a higher BMI might have been protective. The "cysto-under-tension" technique overall may not be that useful in detecting ureteral obstructions but has high negative predictive value.
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Affiliation(s)
- Olivia H Chang
- Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, 9500 Euclid Ave, Desk A81, Cleveland, OH, 44195, USA.
| | - Surabhi Tewari
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jinger Y Sun
- Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, 9500 Euclid Ave, Desk A81, Cleveland, OH, 44195, USA
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Cecile A Ferrando
- Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, 9500 Euclid Ave, Desk A81, Cleveland, OH, 44195, USA
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Zhang Z, Chen D, Deng L, Li W, Wang X, Zhang Y, Liekui F, Feloney MP, Zhang Y. Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cysts: What we learned and a review of the literature. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:185-196. [PMID: 33459688 DOI: 10.3233/xst-200804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To avoid Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cyst (diameter > 70 mm), we present two cases of iatrogenic ureteral injury and discuss their clinical courses and final outcomes. PATIENTS AND METHODS Two male patients (47 years old and 74 years old) with large left simple renal cysts underwent a retroperitoneal laparoscopic operation to treat the cysts. In the first patient, the left proximal ureter was partially transected (Grade 3) during the operation. The injury was identified intraoperatively. The transection was managed with a primary ureteroureterostomy (end to end) along with a double J ureteral stent. In the second patient, the left proximalureter was partially transected (Grade 4). However, the injury was unrecognized postoperatively for two days. After recognition of the complication, the injury was managed with an early primary ureteroureterostomy, which followed a failed attempt to place ureteral stent endoscopically. RESULTS In the first patient, a postoperative urinary leakage developed and lasted for 13 days. During long term follow-up of the first patient after the urine leak resolved, there were no reports of pain in the lumbar region or other discomfort. No recurrence of the renal cyst occurred, which was confirmed with an ultrasound at one year postoperatively. In the second patient a ureteral fistula and severe perirenal infection occurred and lasted for 86 days. The patient ultimately underwent a left nephrectomy after conservative management for this surgical complication failed. This patient developed a chronic wound infection that lasted for 3.14 months following the nephrectomy. During follow-up post nephrectomy, the patient developed stage 3B moderate chronic kidney disease (CKD) (GFR = 30 -44 ml/min). CONCLUSIONS For single large (diameter > 70 mm) renal cysts located at the lower pole of the kidney, it is recommended to not completely dissect out and mobilize the entire renal cyst for cyst decortication in order to avoid injuring the ureter. Iatrogenic ureteral injury increases the risk of readmission and serious life-threatening complications. The immediate diagnosis and proper management ureteric injury can reduce complications and long term sequalae.
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Affiliation(s)
- Zejian Zhang
- Department of Urology,Shenzhen Longhua District Central Hospital,The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province,China
| | - Dong Chen
- Department of Urology,Shenzhen Longhua District Central Hospital,The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province,China
| | - Ling Deng
- Department of Urology,Shenzhen Longhua District Central Hospital,The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province,China
| | - Wei Li
- Department of Urology,Shenzhen Longhua District Central Hospital,The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province,China
| | - Xisheng Wang
- Department of Urology,Shenzhen Longhua District Central Hospital,The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province,China
| | - Yixiang Zhang
- Department of Urology, Shenzhen People's Hospital,The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong Province,China
| | - Fang Liekui
- Department of Urology, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen third people's hospital, Shenzhen, Guangdong Province, China
| | - Michael P Feloney
- Department of Urology, Creighton University School of Medicine, Omaha, NE, USA
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Pollack LM, Lowder JL, Keller M, Chang SH, Gehlert SJ, Olsen MA. Racial/Ethnic Differences in the Risk of Surgical Complications and Posthysterectomy Hospitalization among Women Undergoing Hysterectomy for Benign Conditions. J Minim Invasive Gynecol 2021; 28:1022-1032.e12. [PMID: 33395578 DOI: 10.1016/j.jmig.2020.12.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/25/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE Evaluate whether 30- and 90-day surgical complication and postoperative hospitalization rates after hysterectomy for benign conditions differ by race/ethnicity and whether the differences remain after controlling for patient, hospital, and surgical characteristics. DESIGN Retrospective cohort study using administrative data. The exposure was race/ethnicity. The outcomes included 5 different surgical complications/categories and posthysterectomy inpatient hospitalization, all identified through 30 and 90 days after hysterectomy hospital discharge, with the exception of hemorrhage/hematoma, which was only identified through 30 days. To examine the association between race/ethnicity and each outcome, we used logistic regression with clustering of procedures within hospitals, adjusting for patient and hospital characteristics and surgical approach. SETTING Multistate, including Florida and New York. PATIENTS Women aged ≥18 years who underwent hysterectomy for benign conditions using State Inpatient Databases and State Ambulatory Surgery Databases. INTERVENTIONS Hysterectomy for benign conditions. MEASUREMENTS AND MAIN RESULTS We included 183 697 women undergoing hysterectomy for benign conditions from January 2011 to September 2014. In analysis, adjusting for surgery route and other factors, black race was associated with increased risk of 30-day digestive system complications (multivariable adjusted odds ratio [aOR], 1.98; 95% confidence interval [CI], 1.78-2.21), surgical-site infection (aOR, 1.34; 95% CI, 1.18-1.53), posthysterectomy hospitalization (aOR, 1.31; 95% CI, 1.22-1.40), and urologic complications (aOR, 1.16; 95% CI, 1.01-1.34) compared with white race. Asian/Pacific Islander race was associated with increased risk of 30-day urologic complications (aOR, 1.48; 95% CI, 1.08-2.03), intraoperative injury to abdominal/pelvic organs (aOR, 1.46; 95% CI, 1.23-1.75), and hemorrhage/hematoma (aOR, 1.33; 95% CI, 1.06-1.67) compared with white race. Hispanic ethnicity was associated with increased risk of 30-day posthysterectomy hospitalization (aOR, 1.11; 95% CI, 1.02-1.20) compared with white race. All findings were similar at 90 days. CONCLUSION Black and Asian/Pacific Islander women had higher risk of some 30- and 90-day surgical complications after hysterectomy than white women. Black and Hispanic women had higher risk of posthysterectomy hospitalization. Intervention strategies aimed at identifying and better managing disparities in pre-existing conditions/comorbidities could reduce racial/ethnic differences in outcomes.
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Affiliation(s)
- Lisa M Pollack
- Division of Public Health Sciences, Department of Surgery (Drs. Pollack, Chang, Gehlert, and Olsen); Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology (Dr. Lowder); Division of Infectious Diseases, Department of Medicine (Dr. Olsen and Mr. Keller), Washington University School of Medicine in St. Louis; Department of Public Health-Social Work, George Warren Brown School of Social Work, Washington University in St. Louis (Dr. Gehlert), St. Louis, Missouri; Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California (Dr. Gehlert).
| | - Jerry L Lowder
- Division of Public Health Sciences, Department of Surgery (Drs. Pollack, Chang, Gehlert, and Olsen); Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology (Dr. Lowder); Division of Infectious Diseases, Department of Medicine (Dr. Olsen and Mr. Keller), Washington University School of Medicine in St. Louis; Department of Public Health-Social Work, George Warren Brown School of Social Work, Washington University in St. Louis (Dr. Gehlert), St. Louis, Missouri; Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California (Dr. Gehlert)
| | - Matt Keller
- Division of Public Health Sciences, Department of Surgery (Drs. Pollack, Chang, Gehlert, and Olsen); Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology (Dr. Lowder); Division of Infectious Diseases, Department of Medicine (Dr. Olsen and Mr. Keller), Washington University School of Medicine in St. Louis; Department of Public Health-Social Work, George Warren Brown School of Social Work, Washington University in St. Louis (Dr. Gehlert), St. Louis, Missouri; Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California (Dr. Gehlert)
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery (Drs. Pollack, Chang, Gehlert, and Olsen); Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology (Dr. Lowder); Division of Infectious Diseases, Department of Medicine (Dr. Olsen and Mr. Keller), Washington University School of Medicine in St. Louis; Department of Public Health-Social Work, George Warren Brown School of Social Work, Washington University in St. Louis (Dr. Gehlert), St. Louis, Missouri; Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California (Dr. Gehlert)
| | - Sarah J Gehlert
- Division of Public Health Sciences, Department of Surgery (Drs. Pollack, Chang, Gehlert, and Olsen); Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology (Dr. Lowder); Division of Infectious Diseases, Department of Medicine (Dr. Olsen and Mr. Keller), Washington University School of Medicine in St. Louis; Department of Public Health-Social Work, George Warren Brown School of Social Work, Washington University in St. Louis (Dr. Gehlert), St. Louis, Missouri; Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California (Dr. Gehlert)
| | - Margaret A Olsen
- Division of Public Health Sciences, Department of Surgery (Drs. Pollack, Chang, Gehlert, and Olsen); Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology (Dr. Lowder); Division of Infectious Diseases, Department of Medicine (Dr. Olsen and Mr. Keller), Washington University School of Medicine in St. Louis; Department of Public Health-Social Work, George Warren Brown School of Social Work, Washington University in St. Louis (Dr. Gehlert), St. Louis, Missouri; Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California (Dr. Gehlert)
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Cost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2020; 28:1470-1483. [PMID: 33310171 DOI: 10.1016/j.jmig.2020.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/06/2020] [Accepted: 12/06/2020] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To estimate the rate of lower urinary tract injury (LUTI) and percentage of LUTI needing to be recognized intraoperatively to make universal cystoscopy cost-effective and cost-saving during laparoscopic hysterectomy. DESIGN A decision tree model was used to estimate the costs and quality-adjusted life years associated with delayed or intraoperative recognition of LUTI at the time of laparoscopic hysterectomy. Probabilities and utilities were estimated from published literature. Costs were estimated from Medicare national reimbursement schedules. Threshold analyses estimated the LUTI rate and cystoscopy sensitivity that would make universal cystoscopy cost-effective or cost-saving. Monte Carlo simulations were performed. SETTING US healthcare system. PATIENTS Individuals undergoing laparoscopic hysterectomy for benign indications. INTERVENTIONS Theoretic implementation of a universal cystoscopy policy. MEASUREMENTS AND MAIN RESULTS The total direct medical costs of laparoscopic hysterectomy under usual care were $8831 to $9149 and under universal cystoscopy were $8944 to $9068. When low LUTI rates (0.44%; estimated using sample-weighted estimates of retrospective and prospective data) were assumed, universal cystoscopy was only cost-effective in 17.1% of the simulations; the incremental cost was estimated to be $111 to $131. With median LUTI rates (2.3%) or high LUTI rates (4.0%; estimated using only prospective data with universal screening), the universal cystoscopy strategy was cost-effective in 93.9% and 99.6% of the simulations, respectively, and potentially cost-saving if the sensitivity of intraoperative cystoscopy for ureteral injury exceeded 65% or 31%, respectively. The estimated potential savings were $18 to $95 per hysterectomy. In threshold analysis assuming the average cystoscopy sensitivity rate, universal cystoscopy is estimated to be cost-effective when the LUTI rate exceeds 0.80%. CONCLUSION In our model, universal cystoscopy is the preferred approach for laparoscopic hysterectomy and is estimated to be cost-effective in contemporary clinical settings where the LUTI rate is estimated to be 1.8% and potentially cost-saving among higher-risk populations, including those with endometriosis or pelvic organ prolapse. If the LUTI rates are less than 0.75%, the estimated incremental costs are modest-up to $131 per case. Administrators and providers should consider the local LUTI rates and practice patterns when planning implementation of a universal cystoscopy policy.
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Safrai M, Stern S, Gofrit ON, Hidas G, Kabiri D. Urinary tract injuries during cesarean delivery: long-term outcome and management. J Matern Fetal Neonatal Med 2020; 35:3547-3554. [PMID: 33016166 DOI: 10.1080/14767058.2020.1828336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Myriam Safrai
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shira Stern
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Doron Kabiri
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Propst K, Harnegie MP, Ridgeway B. Evaluation of Strategies to Prevent Urinary Tract Injury in Minimally Invasive Gynecologic Surgery: A Systematic Review. J Minim Invasive Gynecol 2020; 28:684-691.e2. [PMID: 32730987 DOI: 10.1016/j.jmig.2020.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To systematically review tools for the prevention of urinary tract injury in adult women undergoing minimally invasive gynecologic surgery. DATA SOURCES 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. METHODS OF STUDY SELECTION 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 was <50% gynecologic or <50% minimally invasive, it was excluded. Articles evaluating techniques for the diagnosis or management of injury, rather than prevention, were excluded. TABULATION, INTEGRATION, AND RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Katie Propst
- Department of Urogynecology and Pelvic Floor Disorders, Ob/Gyn & Women's Health Institute (Drs. Propst and Ridgeway).
| | - Mary Pat Harnegie
- Library Services, Floyd D. Loop Alumni Library (Ms. Harnegie), Cleveland Clinic, Cleveland, Ohio
| | - Beri Ridgeway
- Department of Urogynecology and Pelvic Floor Disorders, Ob/Gyn & Women's Health Institute (Drs. Propst and Ridgeway)
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Lau LW, Luciano M, Schnermann M, Cha J. Ureter Identification In an Inflammatory Pig Model Using a Novel Near-Infrared Fluorescent Dye. Lasers Surg Med 2020; 52:537-542. [PMID: 31579963 PMCID: PMC8274938 DOI: 10.1002/lsm.23165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Ureters are at risk of injury in settings of inflammation and distorted anatomy. The use of a fluorescent dye can improve intraoperative ureteral identification without the need for any additional invasive procedures. Our team has previously described the development of a preclinical ureter-specific dye, UL-766, tested in a rat model. Here, we present the use of the fluorescent dye during laparoscopy to assist in ureteral identification in a swine model with an inflamed abdomen; the results of this study serve as proof of feasibility for use in the setting of tissue edema and erythema. STUDY DESIGN/MATERIALS AND METHODS With institutional approval, two 20-25 kg pigs underwent abdominal surgery with the use of a Food and Drug Administration-approved fluorescence laparoscopic system. Using standard laparoscopy, inflammation was induced with sharp and blunt dissection and irritation was induced with gauze. The animals were allowed to recover and returned to the operating room after 7 days. Images of the inflamed right retroperitoneum, with fluorescence imaging, turned on, were taken before and after intravenous injection of the novel fluorescent dye at 120 μg/kg. The time until fluorescence visualization of the ureters was measured, and the fluorescent signal was measured for up to 4 hours from the time of the initial dye injection. Partial and complete transection of ureteral injuries was made by scissors and monitored under both standard video and fluorescence laparoscopy. RESULTS Inflammation reduced the certainty of ureter identification by white light alone. Despite surrounding tissue erythema and edema, ureteral visualization under fluorescence laparoscopy was achieved within 5-10 minutes after dye injection. The fluorescent signal remained visible for at least 4 hours after injection, and the fluorescent dye showed a partial ureteral injury that would not have been observed under standard laparoscopy. CONCLUSIONS UL-766 is a preclinical fluorescent dye useful for the intraoperative identification of the ureters and ureteral injuries in an inflamed abdomen. With the acquisition of additional preclinical data, this novel dye can be a valuable tool during laparoscopic abdominal and pelvic surgeries. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Lung Wai Lau
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, 111 Michigan Avenue NW, Washington, District of Columbia, 20010
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, Ohio, 44106
| | - Michael Luciano
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, 376 Boyles St., Frederick, Maryland, 21702
| | - Martin Schnermann
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, 376 Boyles St., Frederick, Maryland, 21702
| | - Jaepyeong Cha
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, 111 Michigan Avenue NW, Washington, District of Columbia, 20010
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, 2300 Eye Street Northwest, Washington, District of Columbia, 20052
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Risk factors and long-term impact of urologic complications during radical hysterectomy for cervical cancer in China, 2004-2016. Gynecol Oncol 2020; 158:294-302. [PMID: 32507516 DOI: 10.1016/j.ygyno.2020.05.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/18/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The primary objective was to describe the incidence and risk factors of urologic complications during radical hysterectomy for cervical cancer. The secondary objective was to investigate the impact of urologic complications on long-term survival. METHODS Patients who underwent radical hysterectomy for cervical cancer from 2004 to 2016 were identified in the MSCCCC (Major Surgical Complications of Cervical Cancer in China) database. Data on demographic characteristics, clinical characteristics, hospital characteristics and urologic complications were collected. Multivariable logistic regression was used to assess the risk factors of urologic complications and Cox proportional hazards models were performed to identify prognostic factors. RESULTS A total of 21,026 patients undergoing radical hysterectomy for cervical cancer were identified. The incidence of any urologic complications was 1.54%: 83 (0.39%) ureteral injuries, 17 (0.08%) bladder injuries, 1 (0.005%) ureteral injury combined with bladder injury, and 223 (1.05%) genitourinary fistulas. In a multivariable analysis, surgery at a women and children's hospital (OR = 2.26, 95% CI 1.47-3.48), surgery at a facility in a first-tier city (OR = 2.08, 95% CI 1.24-3.48), and laparoscopic surgery (OR = 4.68, 95% CI 3.44-6.36) were associated with a higher risk of urologic complications. Cox proportional hazards models revealed that the occurrence of urologic complications was a significant predictor of 2-year overall survival (OR = 1.78, 95% CI = 1.09-2.92), but was not a predictor of 5-year overall survival (OR = 1.27, 95% CI = 0.83-1.94). CONCLUSION The incidence of urologic complications during radical hysterectomy is low. The risk of urologic complications may be higher for patients who are treated at a women and children's hospital, are treated in first-tier city hospitals, and receive laparoscopic surgery. Urologic complications have an impact on short-term survival, but not on long-term survival.
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Real-time ureteral identification with novel, versatile, and inexpensive catheter. Surg Endosc 2020; 34:3669-3678. [DOI: 10.1007/s00464-019-07261-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/11/2019] [Indexed: 12/12/2022]
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Chang EJ, Mandelbaum RS, Nusbaum DJ, Violette CJ, Matsushima K, Klar M, Matsuzaki S, Machida H, Kanao H, Roman LD, Matsuo K. Vesicoureteral Injury during Benign Hysterectomy: Minimally Invasive Laparoscopic Surgery versus Laparotomy. J Minim Invasive Gynecol 2019; 27:1354-1362. [PMID: 31743796 DOI: 10.1016/j.jmig.2019.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/27/2019] [Accepted: 11/02/2019] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE The findings of previous studies have been inconsistent as to whether benign hysterectomy via minimally invasive laparoscopic surgery increases the risk of vesicoureteral injury when compared with laparotomy. The objectives of our study were to (1) examine the rate of vesicoureteral injury on benign hysterectomy by the surgical approach and (2) compare the risk of vesicoureteral injury specifically between minimally invasive laparoscopic and abdominal hysterectomy on a populational level. DESIGN Retrospective population-based observational study. SETTING The National Inpatient Sample. PATIENTS A total of 501 110 women who had undergone hysterectomy for benign gynecologic disease between January 2012 and September 2015 were included as follows: total abdominal hysterectomy (TAH, n = 284 365 [56.7%]), total laparoscopic hysterectomy (TLH, n = 60 410 [12.1%]), abdominal supracervical hysterectomy (Abd-SCH, n = 55 655 [11.1%]), laparoscopic-assisted vaginal hysterectomy (LAVH, n = 45 620 [9.1%]), total vaginal hysterectomy (TVH, n = 34 865 [7.0%]), and laparoscopic supracervical hysterectomy (LSC-SCH, n = 20 195 [4.0%]). INTERVENTIONS A comprehensive risk assessment for vesicoureteral injury by hysterectomy mode was performed, adjusting for patient demographics and gynecologic disease types. Propensity score inverse probability of treatment weighing was used to compare (1) TLH versus TAH and (2) LSC-SCH versus Abd-SCH with generalized estimating equations. In a sensitivity analysis, gynecologic disease-specific injury risk and vaginal route-specific injury risk (LAVH vs TVH) were assessed. MEASUREMENTS AND MAIN RESULTS Vesicoureteral injury was reported in 1045 (0.21%) women overall. LAVH (0.28%) had the highest bladder injury rate, whereas LSC-SCH had the lowest (0.10%) (p <.001). TLH (0.13%) had the highest ureteral injury rate, whereas TAH had the lowest (0.04%) (p <.001). In propensity score inverse probability of treatment weighing models, compared with TAH, TLH was associated with an increased risk of ureteral injury (odds ratio [OR] 3.95, 95% confidence interval [CI] 2.03-7.67, p <.001) but not bladder injury (OR 1.04, 95% CI 0.57-1.90, p = .897). Risk of ureteral injury was particularly high when TLH was performed for endometriosis (OR 6.15, 95% CI 1.18-31.9, p = .031) or for uterine myoma (OR 4.15, 95% CI 2.13-8.11, p <.001). In contrast, for supracervical or vaginal hysterectomy, minimally invasive laparoscopic approaches were not associated with an increased risk of vesicoureteral injury (LSC-SCH vs Abd-SCH: OR 0.62, 95% CI 0.19-1.98, p = .419; LAVH vs TVH: OR 1.21, 95% CI 0.63-2.33, p = .564). CONCLUSION The risk of vesicoureteral injury on benign hysterectomy is low overall regardless of hysterotomy modalities but varies widely with the surgical approach. Compared with TAH, TLH may be associated with an increased risk of ureteral injury.
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Affiliation(s)
- Erica J Chang
- Department of Obstetrics and Gynecology, Divisions of Gynecologic Oncology (Drs. Chang, Mandelbaum, Matsuzaki, Roman, and Matsuo, Mr. Nusbaum, and Ms. Violette)
| | - Rachel S Mandelbaum
- Department of Obstetrics and Gynecology, Divisions of Gynecologic Oncology (Drs. Chang, Mandelbaum, Matsuzaki, Roman, and Matsuo, Mr. Nusbaum, and Ms. Violette)
| | - David J Nusbaum
- Department of Obstetrics and Gynecology, Divisions of Gynecologic Oncology (Drs. Chang, Mandelbaum, Matsuzaki, Roman, and Matsuo, Mr. Nusbaum, and Ms. Violette)
| | - Caroline J Violette
- Department of Obstetrics and Gynecology, Divisions of Gynecologic Oncology (Drs. Chang, Mandelbaum, Matsuzaki, Roman, and Matsuo, Mr. Nusbaum, and Ms. Violette)
| | | | - Maximilian Klar
- Department of Obstetrics and Gynecology (Dr. Klar), University of Freiburg, Freiburg, Germany
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Divisions of Gynecologic Oncology (Drs. Chang, Mandelbaum, Matsuzaki, Roman, and Matsuo, Mr. Nusbaum, and Ms. Violette)
| | - Hiroko Machida
- Department of Obstetrics and Gynecology (Dr. Machida), Tokai University School of Medicine, Kanagawa, Japan
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology (Dr. Kanao), Cancer Institute Hospital, Tokyo, Japan
| | - Lynda D Roman
- Department of Obstetrics and Gynecology, Divisions of Gynecologic Oncology (Drs. Chang, Mandelbaum, Matsuzaki, Roman, and Matsuo, Mr. Nusbaum, and Ms. Violette); Norris Comprehensive Cancer Center (Drs. Roman and Matsuo), University of Southern California, Los Angeles, California
| | - Koji Matsuo
- Department of Obstetrics and Gynecology, Divisions of Gynecologic Oncology (Drs. Chang, Mandelbaum, Matsuzaki, Roman, and Matsuo, Mr. Nusbaum, and Ms. Violette); Norris Comprehensive Cancer Center (Drs. Roman and Matsuo), University of Southern California, Los Angeles, California.
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Xiong SW, Yang KL, Ding GP, Hao H, Li XS, Zhou LQ, Guo YL. [Advances in surgical repair of ureteral injury]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:783-789. [PMID: 31420641 DOI: 10.19723/j.issn.1671-167x.2019.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ureteral injury can be classified as iatrogenic or traumatic, which represents a rare but challenging field of reconstructive urology. Due to their close proximity to vital abdominal and pelvic organs, the ureters are highly susceptible to iatrogenic injury, while ureteral injury caused by external trauma is relatively rare. The signs of ureteric injury are difficult to identify initially and often present after a delay. The treatment of ureteral injury, which is depended on the type, location, and degree of injury, the time of diagnosis and the patient's overall clinical condition, ranges from simple endoscopic management to complex surgical reconstruction. And long defect of the ureter presents much greater challenges to urologists. Ureterotomy under endoscopy using laser or cold-knife is available for the treatment of 2-3 cm benign ureteral injuries or strictures. Pyeloplasty is an effective treatment for ureteropelvic junction obstruction and some improved methods showed the possibility of repairing long-segment (10-15 cm) stenosis. Proximal and mid-ureteral injuries or strictures of 2-3 cm long can often be managed by primary ureteroureterostomy. When not feasible due to ureteral defects of longer segment, mobilization of the kidney should be considered, and transureteroureterostomy is alternative if the proximal ureter is of sufficient length. And autotransplantation or nephrectomy is regarded as the last resorts. Most of the injuries or strictures are observed in the distal ureter, below the pelvic brim, and are usually treated with ureteroneocystostomy. A non-refluxing technique together with a ureteral nipple or submucosal tunnel method, is preferable as it minimizes vesico-ureteral reflux and the risk of infection. In order to cover a longer distance, ureteroneocystostomy in combination with a psoas hitch (covering 6-10 cm of defect) or a Boari flap (covering 12-15 cm) is often adopted. Among various ureteral replacement procedures, only intestinal ureteral substitution, which includes ileal ureter, appendiceal interposition and reconfigured colon substitution, has gained wide acceptance when urothelial tissue is insufficient. Ileal ureter can be used to replace the ureter of >15 cm defect and even to replace the entire unbilateral ureter or bilateral ureter. Laparoscopic and robotic-assisted techniques are increasingly being employed for ureteral reconstruction and adopted with encouraging results.
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Affiliation(s)
- S W Xiong
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - K L Yang
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - G P Ding
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - H Hao
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - X S Li
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - L Q Zhou
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - Y L Guo
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
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