URETERAL INJURY DURING GYNECOLOGICAL LAPAROSCOPIC SURGERIES: REPORT OF TWELVE CASES

Objective To investigate ureteral injury during gynecological laparoscopic surgeries.Methods From January 1990 to December 2005, 12868 gynecological laparoscopic surgeries were conducted in Peking Union Medical College Hospital with 12 ureteral injuries reported. The present study investigated several aspects, including surgical indications, uterine size, pelvic adhesion, operative procedures, symptoms, diagnostic time and methods, injury site and type, subsequent treatment, and prognosis. Results The incidence of ureteral injury was 0.093% (12/12868) in all cases, 0.42% (11/2586) in laparoscopic hysterectomy [laparoscopically assisted vaginal hysterectomy (LAVH) or total laparoscopic hysterectomy (TLH)], and 0.01% (1/10282) in non-LAVH surgeries. Enlarged uterus, pelvic adhesion, and endometrosis were risk factors associated with ureteral injury. Only one injury was found intraoperatively while others were found postoperatively. The injury sites were at the pelvic brim (2 cases) or the lower part of ureter (10 cases). Patients were treated with ureteral stenting (effective in 2 cases) or laparotomy and open repair. Prognoses were favorable in most cases. Conclusions Most laparoscopic ureteral injuries occur during laparoscopic hysterectomy. Further evaluation is required when ureteral injury is suspected, and surgical repair is the major treatment for ureteral injury.

Migration of varicocele coil leading to ureteral obstruction and hydronephrosis:A case report

BACKGROUND Varicocele embolization,a minimally invasive treatment for symptomatic varicoceles,carries a rare risk of complications like ureteral obstruction and hydronephrosis.This case report documents such a case to raise awareness of these potential complications and showcase minimally invasive surgical management as a successful solution.CASE SUMMARY A 35-year-old male presented with flank pain and hematuria following varicocele embolization.Imaging confirmed left ureteral obstruction and hydronephrosis.Laparoscopic ureterolysis successfully removed the embolization coil and repaired the ureter,resolving the patient's symptoms.Follow-up at six months and two years showed sustained improvement.CONCLUSION Minimally invasive surgery offers an effective treatment option for rare complications like ureteral obstruction arising from varicocele embolization.

Intraoperative Ureteral Identification Utilizing StimSite™ Technology during Robotic-Assisted Sacral Colpopexy Procedure: A Case Report

Identification of the pelvic ureter location is crucial during robotic-assisted sacral colpopexy procedures to avoid iatrogenic injury. In this case study, StimSite&#8482 technology (Allotrope Medical;Houston, TX) was used to assist with ureter identification. StimSite is a novel, minimally invasive surgical device designed to facilitate ureter identification by delivering on-demand mild electrical impulses to stimulate visible ureteral peristalsis. Visualization of the ureter can help prevent inadvertent injury which can cause significant patient morbidity, and in some cases mortality. The use of StimSite permitted ureter mapping along the pelvic sidewall and assisted with creating the proper peritoneal dissection for synthetic mesh placement. StimSite provides a minimally invasive, time-conscious option for real-time ureter identification during robotic-assisted sacral colpopexy procedures.

Robot-assisted laparoscopic pyeloureterostomy for ureteropelvic junction rupture sustained in a traffic accident:A case report

BACKGROUND Ureteral reconstruction is a highly technical type of laparoscopic or open surgery.The incidence of ureteral injury is low;however,ureteral injuries tend to be overtreated.Robotic surgery for urinary reconstructive surgery is growing in popularity,which has made procedures such as pyeloplasty,ureteroureterostomy,and ureteroneocystostomy possible,with minimal damage to the patient.To the best of our knowledge,this is the first report of robot-assisted laparoscopic pyeloureterostomy in Korea,in a 17-year-old female patient with a ureteral injury.CASE SUMMARY The patient,a 17-year-old girl without previous medical history,was presented at the emergency room and complained of abdominal and back pain.Tenderness in the right upper quadrant was observed on physical examination.Hemorrhage in the right perirenal space was observed without abdominal organ injuries on the initial enhanced abdomen computed tomography(CT)scan.Ureteral injury was not suspected at this time.The patient was stabilized via conservative treatment,but complained of right flank pain 3 wk later and revisited the emergency room.An enhanced abdominal CT scan revealed a huge urinoma in the right perirenal space with hydronephrosis of the right kidney.Retrograde and antegrade pyelography were performed.Extravasation and discontinuity of the ureter were found.A rupture of the ureteropelvic junction was diagnosed and reconstructive surgery was performed.After 3 mo,the patient did not complain of any symptoms without any abnormal radiologic findings.CONCLUSION This case report discusses the safety and effectiveness of this minimal invasive procedure as an alternative to conventional open or laparoscopic surgery.

Urological Complications of Gynecological and Obstetric Interventions: Management at the Ignace Deen National Hospital—University Hospital of Conakry (Guinea)

Introduction: pelvic abdominal surgery may be associated with urological complications requiring reoperation. The aim of this study was to evaluate the urological surgical complications of gynecological and obstetric procedures conducted at the Ignace Deen University Hospital of Conakry in Guinea. Methodology: This was a retrospective, cross-sectional, descriptive study of ten years, from 1 January 2006 to 21 December 2015. Results: Of 14,500 patients hospitalized in the maternity ward during the study period, 31 patients had secondary urological complications during gynecological or obstetric intervention 0.2%). The mean age of the patients was 34.77 years (range: 17 to 58 years). The mean duration of hospital stay was 13.29 days (range: 3 to 28 days). Signs of complication were mainly postoperative abdominal pain (64%, n = 20), vaginal urine leakage (19.35%, n = 6) and vaginal bleeding (9.68% n = 3). The diagnosis was mainly confirmed by ultrasound (70.45%, n = 31). The lesions were primarily ureteric (77.42%, n = 17) or on the urethral wounds (8.12%, n = 12). Urological complications mostly occurred during hysterectomy (41.94%, n = 13) and caesarean section (32.26%, n = 10). Repair procedures included uretero-vesical reimplantation (58.06%, n = 18), vesico-vaginal fistuloraphy (22.58%, n = 7), vesico-uterine fistuloraphy (12.90%, n = 4) and temporary ureterostomy (6.45%, n = 2). Treatment were successful in 28 patients (90.32%) and a lethality of 9.68% (n = 3) was recorded. Conclusion: Urological surgical complications of obstetric gynecological surgeries were mostly related to hysterectomy and Caesarean section performed by low-skilled surgeons, from peripheral facilities. Prevention measures should include better training and follow-up of practitioners from peripheral health facilities.