Diagnostic and Interventional Radiology Management of Ureteral Iatrogenic Leakage after Gynecologic Surgery

Fontana, Federico; Piacentino, Filippo; Ossola, Christian; Casarin, Jvan; Coppola, Andrea; Cromi, Antonella; Ierardi, Anna Maria; Carrafiello, Gianpaolo; Basile, Antonio; Dehò, Federico; Ghezzi, Fabio; Carcano, Giulio; Venturini, Massimo

doi:10.3390/diagnostics11050750

Cited by 7 publications

(3 citation statements)

References 25 publications

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“…Ku et al 3 reported a complete resolution rate of 65% in 17 patients with urinary leak treated with both antegrade and retrograde ureteral stent placement. Fontana et al 16 performed ureteral stent placement in 15 patients with urinary leak and reported a complete resolution rate of 53.5%. However, Ustunsoz et al 17 reported a complete resolution rate of 75% in 22 patients with 24 ureteral injuries.…”

Section: Discussionmentioning

confidence: 99%

Role of interventional radiology in the management of iatrogenic urinary tract injury: the factors affecting the outcome

Düzgün¹,

Ünal²,

Çiftçi³

et al. 2023

dir

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To evaluate the efficacy of interventional radiological (IR) procedures in iatrogenic urinary tract injury and investigate the factors affecting the outcome. METHODSFifty-eight patients (21 male) with a mean age of 50.3 ± 15.8 years referred for iatrogenic urinary tract injury were enrolled in this study. Technical success was defined as (i) successful placement of a nephrostomy catheter within the renal pelvis and/or (ii) successful antegrade ureteral stent placement (double J stent) between the renal pelvis and bladder lumen. Complete resolution was defined as maintained ureteral patency without an external drain and ureteral stent. The factors that may affect complete resolution [ureteral avulsion, ureterovaginal fistula (UVF), history of malignancy/radiotherapy, and time to IR management] were also investigated. The receiver operating characteristic analysis was performed to estimate the cut-off time point for the IR management timing affecting complete resolution. RESULTSThe technical success rate for nephrostomy and ureteral stent placement was 100% (n = 58/58) and 78% (n = 28/36), respectively. In 14 patients, non-dilated pelvicalyceal systems were evident. In 18 patients, no further intervention after percutaneous nephrostomy was performed due to (i) poor performance status (n = 6) and (ii) reconstruction surgery upon clinicians' and/or patients' request (n = 12). Reconstruction surgery was required in 11 of the remaining 40 patients due to failure of percutaneous treatment (n = 11/40, 27.5%). In six of the patients, ureteral stents could not be removed due to the development of benign ureteral strictures (n = 6/40, 15%). Our complete resolution rate was 57.5% (n = 23/40). Age, gender, type of surgery (endoscopic or open), side and location of the injury did not statistically affect the complete resolution rate. The presence of ureteral avulsion, history of malignancy and radiotherapy individually or in combination significantly affected the complete resolution rate negatively. The presence of UVF also had a negative effect on the complete resolution rate; however, it did not reach statistical significance. Delayed intervention was also a significant factor related to lower complete resolution. The optimal cut-off point of the time interval for favorable clinical outcome was found to be 0-19 th day following the surgery. CONCLUSIONIR procedures are safe and effective in the management of iatrogenic urinary tract injuries. Antegrade ureteral stenting should be performed as soon as possible to establish ureteral integrity without the development of stricture.

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Section: Discussionmentioning

confidence: 99%

Role of interventional radiology in the management of iatrogenic urinary tract injury: the factors affecting the outcome

Düzgün¹,

Ünal²,

Çiftçi³

et al. 2023

dir

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“…The frequency of ureteral injuries (UI) increases significantly during procedures for malignant neoplasms of the genitals [1,2]. Incidences of bilateral UIs are rare, and being reported as isolated cases, but their occurrence present considerable treatment challenges [3,4].…”

Section: Introductionmentioning

confidence: 99%

Delayed Diagnosis and Management of Ureteral Injuries after Procedures Following Gynecological Cancers

Джеремайя

2024

Хирургия. Восточная Европа

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Введение. Повреждение мочеточника (ПМ) считается одним из наиболее частых осложнений после онкогинекологических вмешательств. Цель. Анализ результатов лечения ПМ после онкогинекологических вмешательств, направленный на повышение эффективности их ведения. Материалы и методы. В течение 2010–2022 гг. в клинике урологии наблюдали 30 женщин в возрасте от 35 до 71 года с ПМ, которое произошло при проведении хирургического лечения в гинекологических отделениях по поводу онкозаболеваний органов репродуктивной сферы Т1-Т2. Факт травмы мочеточника подтвержден через 1–90 дней после операции после перевода пациентов в урологический стационар. Результаты. Организация лечения пациентов с ПМ в урологии разделена на 3 этапа. На первом этапе в день поступления все пациенты были обследованы и прооперированы. Структура проведенных операций: у 16 пациентов проведены малоинвазивные эндоскопические процедуры с установкой внутреннего стента мочеточника, у 11 – установлена чрескожная пункционная нефростома, у 3 – уретеронеоцистоанастомоз из открытого доступа. На втором этапе в условиях стационара через 40–90 дней изучены ближайшие результаты проведенных урологических операций. Установлено, что у 18 пациентов проходимость мочеточника восстановлена полностью, остальные пациенты оперированы повторно. На третьем этапе проводилось многолетнее диспансерное наблюдение и реабилитационные мероприятия. Все пациенты через 2 года прошли контрольное стационарное обследование. Хороший результат лечения достигнут у 23 (76,7%) пациентов, удовлетворительный – у 7 (23,3%). Выводы. ПМ при онкогинекологических операциях чаще всего возникали после радикальной гистерэктомии. Эндоурологические вмешательства широко использовались в лечении пациентов с ПМ. Все пациенты с ПМ после восстановления его проходимости нуждаются в длительном динамическом наблюдении уролога. Introduction. Ureteral injuries (UI) are considered one of the most common complications following oncogynecological surgeries. Purpose. Analysis of treatment outcomes of ureteral injuries following oncogynecological procedures, aimed at improving the effectiveness of their management. Materials and methods. Within 2010 to 2022, 30 women aged between 35 to 71 years with UI were managed in the urology clinic, which occurred during surgical procedures for oncological diseases of the reproductive organs in stages T1-T2. Certainty of the UI were detected only in the postoperative period within 1 to 90 days after the primary oncogynecological operation. Results. Management and follow up of the patients by urologists was divided it into 3 stages. At the first stage, all patients were examined, investigated, and operated upon, on the date of admission to the urological hospital. Distribution of the operations are: 16 patients underwent minimally invasive endoscopic ureteral stenting, 11 patients had a percutaneous nephrostomy, and 3 patients had an open access ureteroneocystoanastomosis. At the second stage, after 40–90 days in a hospital settings, short term outcomes of urological operations were analyzed. Findings revealed that, ureteral patency was completely restored in 18 patients, and the remaining 12 underwent surgeries. At the third stage, a long-term outpatient follow-up and rehabilitation program was developed for each patient. In other to study the long-term treatment outcomes, all 30 patients underwent an inpatient follow up check-up after 2 years. A good management outcome was achieved in 23 (76.7%) patients, and a satisfactory outcome – in 7 (23.3%). Conclusion. UIs during the oncogynecological surgeries occurred in most often times following radical hysterectomy 21 (70.0%). Endourological procedures were largely used in the treatment of patients with the UIs. All patients with UI after urological operations, are recommended for long-term dynamic outpatient follow-up.

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“…Consequently, in the event of such an occurrence, the risk of damaging the ureter is increased, where urinary leakage is seen from the wounded ureter [ 45 , 46 , 47 ]. Therefore, a ureteroraphy or segmental ureterectomy with anastomosis should be performed [ 48 , 49 ]. Similarly, in such cases where the ureter was identified before damaging it, there can still be no option to avoid the ureterectomy due to the impossibility of manipulating it out of the herniation process.…”

Section: Introductionmentioning

confidence: 99%

Difficulties in Diagnosing Extraperitoneal Ureteroinguinal Hernias: A Review of the Literature and Clinical Experience of a Rare Encounter in Acute Surgical Care Settings

et al. 2022

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Although inguinal hernia repair is one of the most common surgical procedures, finding a retroperitoneal structure, such as the ureter, is a rather rare occurrence. Ureteroinguinal hernias may arise in the presence or absence of obstructive uropathy, the latter raising difficulties in diagnosis for the general surgeon performing a regular inguinal hernia surgery. This study aims to collect the relevant literature describing the diagnosis and management of ureteroinguinal hernias and update it with a case encountered in our clinic. The following study was reported following the SCARE guidelines. The relevant literature describes less than 150 cases of ureteroinguinal hernias overall, considering the 1.7% prevalence of inguinal hernias in the general population. With only 20% of these hernias being described as extraperitoneal, such an encounter becomes an extremely rare finding. Our clinical experience brings a case of a 75-year-old male with frequent urinary tract infections and a large irreducible inguinoscrotal hernia of about 20/12 cm located at the right scrotum. The patient underwent an open inguinal hernia repair technique under general anesthesia, incidentally finding an extraperitoneal ureteral herniation. Segmental ureterectomy was performed with uneventful recovery. Intraoperatively, finding an incidental ureteroinguinal hernia raises concerns about probable urinary tract complications during regular hernia repair surgery and whether the diagnosis is likely to happen prior to surgical intervention. Although imaging is rarely indicated in inguinal hernias, the case reports show that a pelvic CT scan with urography in symptomatic patients with urinary symptoms will provide accurate confirmation of the diagnosis. The relevant literature is limited due to the rarity of respective cases, thus making standardized management of such cases unlikely.

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Diagnostic and Interventional Radiology Management of Ureteral Iatrogenic Leakage after Gynecologic Surgery

Cited by 7 publications

References 25 publications

Role of interventional radiology in the management of iatrogenic urinary tract injury: the factors affecting the outcome

Role of interventional radiology in the management of iatrogenic urinary tract injury: the factors affecting the outcome

Delayed Diagnosis and Management of Ureteral Injuries after Procedures Following Gynecological Cancers

Difficulties in Diagnosing Extraperitoneal Ureteroinguinal Hernias: A Review of the Literature and Clinical Experience of a Rare Encounter in Acute Surgical Care Settings

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