Objective: To describe the aetiology, clinical presentation, management and outcomes of a series of patients with iatrogenic lesions of the ureter following obstetric or gynaecological surgery treated at Yalgado Ouedr...Objective: To describe the aetiology, clinical presentation, management and outcomes of a series of patients with iatrogenic lesions of the ureter following obstetric or gynaecological surgery treated at Yalgado Ouedraogo University Hospital, Ouagadougou, Burkina Faso. Methods: This is a case series looking at 14 consecutive patients from 1 January 2011 to 28 February 2017, operated on for urological complications following obstetric and gynaecological surgery. Results: Our study focused on fourteen cases. The average age was 32.9 years (range 20 - 60 years). Thirteen were housewives. Eleven lived in rural areas. The aetiological factor was Caesarian section in seven cases, laparotomy in four cases and hysterectomy in three cases. The type of ureteral injury was bilateral ligation in nine cases. The average time to diagnosis was 16 days (range 2 - 120 days). Anuria was the commonest presenting symptom. Ultrasound in ten patients showed evidence of uretero-hydronephrosis. Eight patients required renal dialysis. Surgical management was uretero-vesical re-implantation in eleven cases, disunion of sutures associated with catheterization in two cases and a termino-terminal ureteral anastomosis in one case. The average hospital stay was 26 days (range 9 - 44 days). The post-operative period was complicated by two cases of vesico-vaginal fistula, one case of parietal suppuration, one case of pyelonephritis and one case of hydronephrosis. No deaths were recorded and a complete cure was ultimately obtained in all patients. Conclusion: Urological complications of obstetric and gynaecological surgery are dominated by ligation of the ureters in our setting. Caesarian section is the commonest cause. Treatment is essentially surgical.展开更多
Introduction: Ureteral lesions, most often iatrogenic, generally follow pelvic surgery. They are serious and can be life-threatening. Uretero-vesical reimplantation using the BOARI technique, modified by KUSS, was pop...Introduction: Ureteral lesions, most often iatrogenic, generally follow pelvic surgery. They are serious and can be life-threatening. Uretero-vesical reimplantation using the BOARI technique, modified by KUSS, was popularized in humans in 1954, and appears to be the most appropriate treatment for lesions of the lower ureter with significant loss of substance. Observation: We report in this work a case of iatrogenic ligation of the pelvic ureter on a single functional kidney (of fortuitous discovery) during gynecological surgery, having led to an Alteration of the General State (important Urinoma and collapse of the renal function) and treated by the surgical technique of BOARI KUSS at the urology department of the CHU Le Luxembourg. Follow-up and postoperative follow-up were excellent. Conclusion: Surgical repair of the ureter is very often indicated in cases of stenosis or iatrogenic lesions of the ureter. The BOARI KUSS technique is a good choice in cases of significant loss of substance due to injury to the lower ureter. Gynecological surgery is the main source of these lesions, and the prognosis of the treatment depends on how early the diagnosis is made, the anatomical condition of the ureter and the expertise of the surgical team.展开更多
文摘Objective: To describe the aetiology, clinical presentation, management and outcomes of a series of patients with iatrogenic lesions of the ureter following obstetric or gynaecological surgery treated at Yalgado Ouedraogo University Hospital, Ouagadougou, Burkina Faso. Methods: This is a case series looking at 14 consecutive patients from 1 January 2011 to 28 February 2017, operated on for urological complications following obstetric and gynaecological surgery. Results: Our study focused on fourteen cases. The average age was 32.9 years (range 20 - 60 years). Thirteen were housewives. Eleven lived in rural areas. The aetiological factor was Caesarian section in seven cases, laparotomy in four cases and hysterectomy in three cases. The type of ureteral injury was bilateral ligation in nine cases. The average time to diagnosis was 16 days (range 2 - 120 days). Anuria was the commonest presenting symptom. Ultrasound in ten patients showed evidence of uretero-hydronephrosis. Eight patients required renal dialysis. Surgical management was uretero-vesical re-implantation in eleven cases, disunion of sutures associated with catheterization in two cases and a termino-terminal ureteral anastomosis in one case. The average hospital stay was 26 days (range 9 - 44 days). The post-operative period was complicated by two cases of vesico-vaginal fistula, one case of parietal suppuration, one case of pyelonephritis and one case of hydronephrosis. No deaths were recorded and a complete cure was ultimately obtained in all patients. Conclusion: Urological complications of obstetric and gynaecological surgery are dominated by ligation of the ureters in our setting. Caesarian section is the commonest cause. Treatment is essentially surgical.
文摘Introduction: Ureteral lesions, most often iatrogenic, generally follow pelvic surgery. They are serious and can be life-threatening. Uretero-vesical reimplantation using the BOARI technique, modified by KUSS, was popularized in humans in 1954, and appears to be the most appropriate treatment for lesions of the lower ureter with significant loss of substance. Observation: We report in this work a case of iatrogenic ligation of the pelvic ureter on a single functional kidney (of fortuitous discovery) during gynecological surgery, having led to an Alteration of the General State (important Urinoma and collapse of the renal function) and treated by the surgical technique of BOARI KUSS at the urology department of the CHU Le Luxembourg. Follow-up and postoperative follow-up were excellent. Conclusion: Surgical repair of the ureter is very often indicated in cases of stenosis or iatrogenic lesions of the ureter. The BOARI KUSS technique is a good choice in cases of significant loss of substance due to injury to the lower ureter. Gynecological surgery is the main source of these lesions, and the prognosis of the treatment depends on how early the diagnosis is made, the anatomical condition of the ureter and the expertise of the surgical team.
