Evolution in the approach to overlooked ureteral injuries after gynecological surgery

Borkowski, Tomasz; Judycki, J; Borkowski, Andrzej; Czaplicki, M; Radziszewski, Piotr

doi:10.5603/gp.2016.0069

Cited by 4 publications

(4 citation statements)

References 22 publications

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“…Renal cell carcinoma (RCC) accounts for about 4% of all adult malignancies. RCC occurs in both sporadic and heritable forms ( 1 ). Genetic mutations have been identified as the cause of inherited cancer in 1–2% of RCC.…”

Section: Introductionmentioning

confidence: 99%

Checkpoint Kinase 2 (CHEK2) Mutation in Renal Cell Carcinoma: A Single-Center Experience

Huszno

Kołosza

2018

jkcvhl

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Renal cell carcinoma (RCC) occurs in sporadic and heritable forms. Genetic mutations have been identified as risk factors in 1–2% of RCC. The aim of this study was to evaluate I157T and CHEK2*1100delC mutations of checkpoint kinase 2 (CHEK2) gene in RCC. Medical records of 40 clear cell RCC patients who had genetic tests and consultation at the Genetic Outpatient Clinic, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland, were reviewed retrospectively. Mutation profile was assessed by ASA-PCR and RFLP-PCR techniques. Only three female patients had CHEK2 mutation (I157T). No CHEK2*1100delC was observed in any of the patients. These tumors were N0, and two were Grade 3. One showed capsular infiltration. No blood vessel infiltration or metastases was observed. Overall, RCC from patients with CHEK2 mutation did not display any special characteristics when compared with those without the mutation. While no association between CHEK2 mutation and RCC could be established, all three patients with CHEK2 mutation developed second neoplasms many years after first diagnosis. Further studies, especially regarding CHEK2 mutation as a predictive factor for second neoplasm in RCC patients, are warranted.

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Section: Introductionmentioning

confidence: 99%

Checkpoint Kinase 2 (CHEK2) Mutation in Renal Cell Carcinoma: A Single-Center Experience

Huszno

Kołosza

2018

jkcvhl

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“…Therefore, further management, primarily ureteral stent placement, is mandatory for complete resolution. Borkowski et al 9 reported a complete recovery of 28.6% (6/21) with percutaneous nephrostomy alone, while this rate was 83% (5/6) for the ureteral stent group. Similarly, our complete resolution rate with percutaneous nephrostomy alone was relatively low (n = 4/12, 30%), while it was 68% (n = 19/28) for ureteral stent.…”

Section: Discussionmentioning

confidence: 99%

“…8 Urinary diversion by percutaneous nephrostomy may serve as a bridging therapy prior to surgery or can be the definitive treatment. Although Lask et al 7 reported a complete recovery rate of 80% with percutaneous nephrostomy, Borkowski et al 9 reported a recovery rate of 28.6% in patients treated with percutaneous nephrostomy alone. Therefore, ureteral stent placement should be performed following nephrostomy to preserve ureteral integrity.…”

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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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“…Regarding the specific treatment for postoperative ureteral obstruction, recent literature predominantly favors methods using a ureteroscopic retrograde or percutaneous nephrostomy antegrade stent. [25][26][27] Although this procedure is often successful in the case of ureteral kinking, overcoming a real obstruction with splinting of the ureter does not always succeed. In these circumstances it will be necessary to switch to an alternative direct renal urinary drain using a nephrostomy catheter, may be for longer time.…”

Section: The Significance Of An Early Therapeutic Intervention In Ure...mentioning

confidence: 99%

The role of serum creatinine in the early detection of ureteral injury after gynecological and obstetric surgery

Link¹,

Melick²,

Kruitwagen³

2022

OGIJ

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Objective: Ureteral injury is a typical complication in pelvic surgery even though occurring not frequently. The goal of this study was to classify the importance of perioperative assessment of serum creatinine with clinical symptoms concerning the early detection of ureteral lesions after surgery. Patients and methods: The postoperative course of 7 gynecological and 2 obstetric patients raising doubt on ureteral integrity was analyzed, retrospectively, using medical records. Clinical symptoms (urinary production, flank pain), and the temporary changes of serum creatinine (µmol/L) as well as interdisciplinary diagnostic and interventional procedures were recorded. Glomerular filtration rate (GRF) was calculated using CKD-EPI formula (mL/min/1.73m2). Data analysis was done using descriptive statistics, Fisher’s exact test, non-parametric tests, and regression analysis (SPSS). Results: 6/9 patients presented with ureteral impairment. In 5/6 patients unilateral (n=2) and bilateral (n=3) obstructions were detected all deriving from anterior colporrhaphy. 1 patient exhibited ureteral kinking healing spontaneously. In patients affected by ureteral obstruction diminishing of urinary outflow occurred significantly earlier than flank pain (2.8±1.0 vs. 28.8±9.2 hours, p=0.03). Mean increase in serum creatinine and decrease of GFR was from 72±16 before surgery up to 160±34 and from 79±18 down to 30±6 (p=0.07), respectively, within 8–48 hours after surgery being significantly different from respective values in patients without obstruction (p=0.03). The increase in creatinine in patients with unilateral obstruction followed a logarithmic graph indicating interference between deteriorated ipsilateral and functionally compensating contralateral kidney after 24 hours. Conclusion: Perioperative measurement of serum creatinine is useful in testing ureteral integrity. However, the negative predictive value is superior to the positive predictive value. According to decreasing GFR highly important is a contemporary registration of the urine outflow in the first hours after surgery.

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Evolution in the approach to overlooked ureteral injuries after gynecological surgery

Cited by 4 publications

References 22 publications

Checkpoint Kinase 2 (CHEK2) Mutation in Renal Cell Carcinoma: A Single-Center Experience

Checkpoint Kinase 2 (CHEK2) Mutation in Renal Cell Carcinoma: A Single-Center Experience

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

The role of serum creatinine in the early detection of ureteral injury after gynecological and obstetric surgery

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