Iatrogenic Urinary Tract Injuries: Etiology, Diagnosis, and Management

Esparaz, Anthony M.; Pearl, Jeffrey; Herts, Brian R.; LeBlanc, Justin; Kapoor, Baljendra

doi:10.1055/s-0035-1549378

Cited by 62 publications

(47 citation statements)

References 62 publications

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“…Studies have shown that use of coil embolization has little effect on renal function. 18 Gelatin sponge particles are large and embolized arteries can be recanalized, and thus this method is relatively safe. Therefore, gelatin sponge particles can be used as a supplementary embolization after coil embolism.…”

Section: Discussionmentioning

confidence: 99%

Superselective renal artery embolization for bleeding complications after percutaneous renal biopsy: a single-center experience

Wang

Song

et al. 2019

J Int Med Res

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Objective This study aimed to determine if superselective renal artery embolization is a safe and effective method of treating bleeding complications after percutaneous renal biopsy. Methods From January 2006 to December 2017, 43 patients (22 men and 21 women, mean age: 44.5 ± 14.0 years) underwent angiography for post-biopsy bleeding complications following percutaneous biopsy. Patients underwent angiography and superselective artery embolization. We recorded serum creatinine and hemoglobin values to assess the effect of embolization. Results Successful embolization was achieved in all patients. There was a pseudoaneurysm in 10 cases, arteriovenous fistula in eight, contrast media extravasation in 16, arteriovenous fistula combined with contrast media extravasation in five, and pseudoaneurysm combined with arteriovenous fistula in four. The embolic substance was a microcoil only or combined with a gelatin sponge. The mean creatinine value was not different at 1 day and 1 week after embolization compared with before embolization. Mean hemoglobin values were significantly higher at 1 day and 1 week after embolization than before embolization. Conclusions Superselective renal artery embolization is a safe and effective treatment for post-biopsy bleeding complications after percutaneous renal biopsy. Lumbar or iliolumbar artery angiography is necessary if renal arteriography shows no signs of hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Superselective renal artery embolization for bleeding complications after percutaneous renal biopsy: a single-center experience

Wang

Song

et al. 2019

J Int Med Res

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“…A locally advanced tumour stage, rectal carcinoma recurrence, and previous RT also increase the anatomical distortions [11, 12]. Ninety per cent of all iatrogenic injuries to the ureter develop in the distal part of the ureter [13]. A curative resection is possible via the development of new surgical techniques and procedures.…”

Section: Discussionmentioning

confidence: 99%

The effects of rectal cancer surgery on the anatomical localisation of ureters – a prospective observational study

Aday

Gündeş

Çetin

et al. 2019

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IntroductionAnatomical changes after surgery and fibrotic adhesions increase the organ laceration risk, including that of the ureter, in recurrent cases and secondary operations. The aim of this study was to investigate the changes in the anatomical localisations of the ureters via computed tomography urography in patients undergoing rectal cancer surgery.Material and methodsThe study involved prospectively collected data on the changes of ureteral location preoperatively and postoperatively in patients with operated rectal cancer. Distances (mm) of ureters determined midline in the computed tomography urogram phase.ResultsA total of 18 patients were included. The mean distances between the right (R1) and left (L1) ureters and the mid-vertebral line before the surgery were 30.9 ±5.4 mm and 34.5 ±9.9 mm, respectively. The postoperative distances between them (R2 and L2) were 26.4 ±9.1 mm and 29.5 ±9.9 mm, respectively. The R2 measurement showed that 83.3% (15/18) of the right ureters had deviated medially, whereas 16.7% (3/18) of them had deviated laterally. The L2 measurements showed that 88.8% (16/18) of the left ureters had deviated medially, whereas 11.2% (2/18) of them had deviated laterally. The differences between the preoperative and postoperative measurements of the right and left ureter positions were 4.5 ±9.2 mm and 4.9 ±4.6 mm, respectively, with the displacement in the left ureter being statistically significant (p ≤ 0.001).ConclusionsRectal cancer surgery causes medially deviated changes in the positions of the ureters.

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“…Although intra-operative identification and repair of ureteral injuries is associated with better outcomes, 50%–70% of these lesions are missed in acute settings [ 7 ]. Patients with unrecognized injuries can show abdominal pain, fever, anuria, peritonitis, and even vaginal urinary leaking [ 8 ]. In these patients, radiologists play a pivotal role in both the diagnosis of the injury and tailoring of treatment [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Objective: To report safety and efficacy of interventional radiology procedures in the treatment of gynecologic iatrogenic urinary leaks. Methods: A retrospective analysis of iatrogenic ureteral lesions treated between November 2009 to April 2019 was performed. Under ultrasound (US) and fluoroscopy guidance, an attempt to place a ureteral stent and nephrostomy was carried out in the same session using an anterograde percutaneous approach. At the end of any procedure, a fluoroscopic control and a cone-beam CT scan (CBCT) were performed to check the correct placement and functioning of the nephrostomy and DJ stent. In cases of difficult ureteral stent placement via the single anterograde approach, the collaboration of urologists was requested to perform a rendezvous technique, combined with the retrograde approach. Results: DJ stent placement was achieved using the anterograde approach in 12/15 (80.0%) patients and using the retrograde approach in 3/15 cases (20.0%). Moreover, in 3/15 (20.0%) patients, surgical treatment was needed: in one case because of the persistence of ureteral stenosis at 6 months, and in the other two cases due to ureter-vaginal fistula. No major complications were recorded; overall, minor complications occurred in 4/8 patients. Conclusion: Percutaneous minimally invasive treatment of iatrogenic ureteral lesions after gynecological surgery is a safe and effective option.

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Iatrogenic Urinary Tract Injuries: Etiology, Diagnosis, and Management

Cited by 62 publications

References 62 publications

Superselective renal artery embolization for bleeding complications after percutaneous renal biopsy: a single-center experience

Superselective renal artery embolization for bleeding complications after percutaneous renal biopsy: a single-center experience

The effects of rectal cancer surgery on the anatomical localisation of ureters – a prospective observational study

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

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