Complications of Recognized and Unrecognized Iatrogenic Ureteral Injury at Time of Hysterectomy: A Population Based Analysis

Abstract

Iatrogenic ureteral injury increases the risk of hospital readmission and significant, potentially life threatening complications. Unrecognized ureteral injury markedly increases these risks, warranting a high level of suspicion for ureteral injury and a low threshold for diagnostic investigation.

Uterine and fetal placental Doppler indices are associated with maternal cardiovascular function

“…TO THE EDITORS: In their recent paper, Tay et al 1 assert that uterine and fetal placental Doppler indices are significantly associated with measures of maternal cardiovascular function, and go on to state that classic descriptions of uterine and fetal Doppler changes being initiated by placental maldevelopment are a "less plausible explanation" for the pathogenesis of preeclampsia and fetal growth restriction (FGR) than are maternal cardiovascular changes. 1 This conclusion is not supported by the findings described in the paper. Furthermore, their hypothesis fails when applied to pregnancies characterized by high rates of preeclampsia, such as molar pregnancy or trisomy 13, or the case of twin pregnancies with discordance for fetal growth restriction and preeclampsia.…”

“…TO THE EDITORS: We thank Professor Yagel for his observations. We report that uterine and fetal Doppler indices are associated with maternal cardiovascular function, 1 and have previously found that cardiovascular function prior to pregnancy in healthy women is associated with the development of preeclampsia or fetal growth restriction. 2 Although we do not discount a role for the placenta in these pathological processes, the question is whether cardiovascular function or placental maldevelopment initiates them.…”

“…Close examination of the data presented in Tay et al 1 as regards maternal cardiovascular functional parameters shows that their findings are at odds with other studies, including from their group 5 : while they describe a state of increased cardiac output (CO) and decreased peripheral vascular resistance (PVR) in cases with preeclampsia, Foo et al 5 described decreased CO and increased PVR, ie, there is no consensus whether preeclampsia is a hyper-or hypo-dynamic state. Moreover, Tay et al 1 show that compared to control pregnancies, CO was increased in "pure" preeclampsia (without FGR), but decreased in FGR alone or with preeclampsia, and PVR was reduced in "pure" preeclampsia and increased in FGR alone or with preeclampsia. This shows a lack of continuum among these degrees of severity of the clinical presentation.…”

Cost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy

“…Diagnosis during rehospitalization was assumed to include an initial CT scan with confirmatory retrograde pyelogram at the time of stent placement for non-operative management or operative repair. Estimates of subsequent fistula formation, rehospitalization, sepsis and percutaneous nephrostomy placement were incorporated into the model based on data from Blackwell et al (10). Adjusted odds ratios were converted to probability ratios where appropriate (11).…”

Iatrogenic ureteral injuries and their prevention in colorectal surgery: results from a nationwide survey

“…When not recognized intra‐operatively, IUI is difficult to identify, even with dedicated imaging techniques such as urographic‐phase scanners. Such cases of unrecognized IUI have significantly higher rates of sepsis, urinary fistulas and renal impairment, as well as 40% higher mortality ( P = 0.003) .…”