Surgeons should manage endoscopic ureteral injuries with a ureteral stent andor percutaneous nephrostomy tube, when possible. Case reports iatrogenic ureteral injury following radical. The ureter was stented and subsequent fluoroscopic studies showed n. It is not always appropriate for use in the acute setting but may be used in the stable. The ureter is wellprotected in the retroperitoneum by the bony pelvis, psoas muscle, and. A laparotomy was used to repair the ureteral injury in 43 of 70 61. Cut ureter during hysterectomy malpractice lawsuit 2019 update. When the injury is recognized intraoperatively, management depends upon the type of injury. Prevention of ureteric injuries can be achieved by adequate development of. As such, it is important to determine whether injuries occur more frequently in a particular patient population or during specific. Clinical presentation ureteric injuries unreliably demonstrate macro or microscopic hematuria as it may be. Ureteral injury is usually silent, producing no early signs or symptoms.
Prognostic imaging of iatrogenic and traumatic ureteral injury by. The pathophysiology, epidemiology, diagnosis, and treatment of blunt ureteral injury are also discussed. Management of iatrogenic ureteral injury and techniques for. Ureteral laceration can at times be repaired and if ureter is kinked, simple removal of ligature may relieve the obstruction. Iatrogenic injury to the ureter is a potentially devastating complication of modern surgery. Surgical management of the ureter is dictated by the location of the ureteral injury. This helps you give your presentation on burn injuries in a conference, a school lecture, a business proposal, in a webinar and business and professional representations the uploader spent hisher valuable time to create this. Ureteric injury in gyenec surgery, serious complication of gynecologic.
Management of iatrogenic ureteral injury and techniques for ureteral reconstruction article in current opinion in urology 254. Generally, above the ureteral crossover of the common iliac vessels, the arterial blood supply emanates from the medial aspect e. Introduction gynaecologic surgery is the commonest cause of ureteric injury. Iatrogenic ureteral injury is a serious complication that can occur during abdominal or pelvic operations. Most external ureteric injuries occur from gunshot wounds 152. Ureteral injury is one of the possible complications of endometriosis surgery. Manufacturers and importers must submit reports when they become aware of information that reasonably suggests that one of their marketed devices may have caused or contributed to a death or serious injury or has malfunctioned and the malfunction of the device or a similar device that they market would be likely to cause or contribute to a death or serious injury if the malfunction were to. Iatrogenic ureteric injuries following abdominopelvic. Ureteral avulsion is a rare injury, the risks for which are well described and reiterated in this paper. Ureteral dissection can cause a mechanical and sometimes a thermal damage to the ureteral wall. Ureteral injury repair urology coding ask an expert. Overview of traumatic and iatrogenic ureteral injury uptodate. As the ureterovaginal fistula presentation is most often delayed, the patient may. Direct exploration and visual inspection including the exploration of retroperitoneal and peri.
Late manifestation of laparoscopic injury of the ureter. Ureteral visualization is essential for both the prevention and. Oct 30, 2014 ureteral injury is one of the possible complications of endometriosis surgery. Rather than contrast leaking out, the ureter goes into spasm leading to an obstructive uropathy. Ureteral injury is a potential complication of any abdominal or pelvic surgery. Ureteric transection at cesarean section radiology case. Gynecologic, general surgical, and urologic procedures, especially in the pelvis, put the ureter at risk for injury. These rare injuries have a documented incidence of 0. Ureteral injury is an uncommon surgical complication and it is estimated that 5282% of iatrogenic injuries occur during gynecologic surgery. While ureteral injuries are an uncommon surgical complication, it is estimated that 5282% of iatrogenic injuries occur during gynecologic surgery lee et al. Ureteral avulsion as a complication of ureteroscopy.
Thirtysix year old woman with history of two laparoscopies and a laparotomy all because of endometriosis was diagnosed left ovarian. Incidence of iatrogenic ureteral injury after laparoscopic. Although rare, if unrecognized or improperly managed, ureteral injury may lead to the loss of renal function and may even be lifethreatening. The ureter is covered by an anastomotic network of small arteries and veins. Clinicians should have a high suspicion for ureteral injury in the presence of postoperative fever, flank pain, leukocytosis, and peritonitis. There is also potential for considerable ureteral injury during endoscopic procedures for ureteric pathology such as tumor or lithiasis. Several anatomic and physiologic considerations are. There is paucity of data regarding iatrogenic ureteric injuries in tanzania and bugando medical centre in particular. This is one of the most elaborate well prepared, helpful and interesting presentation. Sometimes a connection, called a fistula, develops between the vagina and the ureter, causing urine to leak uncontrollably. Injured ureter during obstetric surgery resulting in multiple surgeries to repair, chronic urinary difficulty and urinary tract infection and pain and discomfort age of patient at injury. Several larger vessels feed and drain this network.
Mar 12, 2015 iatrogenic ureteric injuries are rare complications of abdominopelvic surgery but associated with high morbidity and even mortality. The most common injury is inadvertent ligation of the ureter, with consequent ureteral kinking and obstruction. The defendants claimed that injury to the ureter is a known complication of the procedure in question. Iatrogenic or traumatic ureteral injuries are lifethreatening but difficult to diagnose early. Ureter injury malpractice washington dc patrick malone law. Most of these injuries occur during the performance of hysterectomies. Retrograde placement of doublej ureteric stent is a possible treatment option if the injury. Ppt iatrogenic ureteral injury powerpoint presentation. Damage to the ureters causes more trouble than injuries to other nearby structures like the bladder or rectum. Powerpoint ppt presentation free to view meniscus repair surgery in india in the younger population, your knee meniscus is usually torn traumatically, by a twisting on a slightly flexed knee. Ureteral injuries injuries and poisoning merck manuals. Stepbystep video presentation of the surgical treatment 16.
Ureteral injury is one of the most serious complications of gynecologic surgery. The choice of treatment is based on the location, type, extent, and timing of presentation, as well as the patients medical history, overall condition. Ppt genitourinary trauma powerpoint presentation free. Description of ureteral injuries by specific injury type type of ureteral injury time of diagnosis symptoms diagnostic modality management open procedures n 7 bilateral pod 1 anuria cystourethrogram bilateral nephrostomy tubes transected distal left intraoperative none ureter noted ureteroneocystostomy. These should be evaluated with ct scanning, but rpg may ultimately be necessary. When they occur, the majority of traumatic ureteral injuries are due to a penetrating mechanism, predominantly in. Notwithstanding the possibility of injury to the ureters, such injury to the ureter should be identified before the operation is concluded and immediately repaired. An ebook reader can be a software application for use on a computer.
Ureteral injuries should be suspected in complex, multisystem abdominopelvic trauma patients, such as those with bowel, bladder, or vascular injuries. Maude manufacturer and user facility device experience. When a ureteral injury is suspected, imaging tests are needed. Ureteral injury in laparoscopic gynecologic surgery. If injury to the ureter is suspected intraoperatively the ureter must be meticulously examined in the area of interest.
Ureteric injury during obstetric and gynaecological. To report the vaginoscopic treatment of an iatrogenic ureteral injury in a young patient who underwent abdominal hysterectomy. Iatrogenic lesions of the ureter following obstetric or. Changing incidence and etiology of iatrogenic ureteral injuries. Ureteric injury at gynaecological surgery slideshare. Compared with injury to other genitourinary gu organs, ureteral injury tends to be more often iatrogenic, occurring during pelvic surgery gynecologic, urologic, or colorectal surgery. Learning objectives learner will be able to understand. The site of injury was the upper ureter in 70%, mid in 8% and distal in 22%. Sixteen iatrogenic ureteric injuries in 14 patients over a 2year period were evaluated. Ureteric injury may result from suture ligation, kinking by suture, crushing and loss of blood supply resulting in devascularisation of the ureter. Much of the presentation and management of ureteral injuries are dictated by the severity and management of the associated injuries. This study describes our experience in the management and outcome of ureteric injuries following abdominopelvic operations outlining the causes. Iatrogenic ureteral injury following radical hysterectomy case presentation modern medicine 2017, vol.
Surgeons should repair ureteral injuries located distal to the iliac vessels with ureteral reimplantation or primary repair over a ureteral stent, when possible. The initial test is often computed tomography ct with radiopaque contrast agent. Management of iatrogenic ureteric injury with retrograde. Original article incidence of iatrogenic ureteral injury.
Jan 24, 2020 delayed presentation of ureteral injuries or those missed on initial presentation may be suggested by signs such as fever, leukocytosis, local peritoneal irritation, and leakage of urine from the wound. Urologic, gynecologic, and general surgical procedures were. When iatrogenic ureteral injuries present later in the postoperative course the most common presenting signs and symptoms are abdominal pain with peritonitis. Genitourinary trauma mark boyko em objectives key aspects of gu trauma in an anatomical approach. Jan 24, 2020 ureteral trauma was first reported in 1868 by alfred poland, when a 33yearold woman died 6 days after being pinned between a platform and a railway carriage. At autopsy, the right ureter was avulsed below the renal pelvis. Stents are most commonly used to treat blockages, especially from kidney stones. Hysterectomy of any type is usually a safe procedure, but any surgery has risks, such as blood loss, blood clots, infection, damage to surrounding organs, and reactions to anesthesia. Ureteric injuries during gynaecological surgery ppt dr rahul s. The defendants also claimed that the injury was caused by an electrocautery device that was used during the hysterectomy, and that the actual hole developed two days later and was identified when blood was detected in the plaintiffs urine. Free download burn injuries powerpoint presentation slides.
A case of delayed diagnosis of bilateral ureteral and. External genitalia urethral injury bladder injury ureteral injury. Welcome to prezi, the presentation software that uses motion, zoom, and spatial relationships to bring your ideas to life and make you a great presenter. This study describes our experience in the management and outcome of ureteric injuries following abdominopelvic operations outlining the. A ureteral stent is a thin, strawlike tube, that is put in a ureter to help drain urine from the kidney to the bladder. Less common than injuries to the bladder or rectum, ureteral injuries are far more serious and troublesome and often are associated with a high morbidity, the formation of ureterovaginal fistulas, and the potential loss of kidney function, especially when recognized postoperatively.
The best treatment of ureteral avulsion as a complication of ureteroscopy is prevention, not reconstruction, and all of the contraindications to stone management that may lead to that injury. During the procedure, a crush injury occurs to the right ureter, allegedly because the obgyn did not know the where the uterus was. Urotrauma guideline american urological association. To report the vaginoscopic treatment of an iatrogenic ureteral injury in a young patient who. The diagnosis and management of ureteric injury after. The rate of ureteral injury for vaginal hysterectomy is 0. Ureteric injuries during gynaecological surgery ppt dr. The urologist finds injuries consistent with a significant ureteral injury and places a stent. The diagnosis was done based on clinical presentation, intravenous urogram, computed tomography, cystoscopy, and retrograde pyelogram rgp depending on the clinical situation.
Management of ureteral injuries is dictated by the location, type, extent, timing of presentation, medical history, overall status of the patient, including associated injuries, and prognosis. Presentation software online presentation tools prezi. Delayed presentation of ureteral injuries or those missed on initial presentation may be suggested by signs such as fever, leukocytosis, local peritoneal irritation, and leakage of urine from the wound. The incidence of ureteral and bladder lesions after laparoscopic hysterectomy is the most encountered urinary complication in gynaecological surgery. Such an injury is one of the most serious complications of abdominal, mainly gynecological, surgery. A case of late manifested injury of the left ureter after endometriosis surgery is presented. Iatrogenic ureteric injuries are rare complications of abdominopelvic surgery but associated with high morbidity and even mortality. Broad ligament fibroid the lower portion of the broad ligament is filled with mass the right ureter usually lies below or to the outer side of the tumor mass to avoid injury to the ureter, the peritoneum on the superior surface of the tumour is incised the tumour is enucleated from within its pseudocapsule stay close to the pathological tissue. This is a case series looking at 14 consecutive patients from 1 january 2011 to 28 february 2017, operated on for. Ureter injuries are associated with an incidence of 0.
Traumatic injuries are frequently associated with other severe injuries. Colon cancer or diverticulitis was the indication for 5 of the laparoscopic procedures. One of the more rare etiologies is a urinoma resulting from a ureteral injury. Ureteral injuries can occur during open or laparoscopic intraabdominal, vaginal, and endourological procedures. The choice of treatment is based on the location, type, extent, and timing of presentation, as well as the patients medical history, overall condition, and survival prognosis see surgical therapy. Ureteric injury during obstetric and gynaecological surgery. Ureteral injuries in an obstetrics and gynecology training program. Derick enwezoh this presentation describes the anatomy of the ureter, risk factors for ureteral injury, and key points from the literature relating to slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. It has been reported that 5282% of operative ureteric injuries occur during gynecologic surgery.
Ureteral stent is a thin tube introduced into the ureter to prevent or treat blockage of the urine flow from the kidney. 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. Ureteric injury postgynecological procedure needs a high index of suspicion. Aetiology, presentation and management saadia nawaz durrani, ata ur rehman, sarhad khan, hazrat ullah, muhammad kamran khan, anayat ullah urology and transplant unit, institute of kidney diseases, hayatabad medical complex, peshawar, pakistan. Injuries to the ureter during gynaecological operations. Ureter injury generally speaking, gynecologic surgery accounts for over 50% of all ureteral injuries resulting from operations. The thermal injury or injury by stapling devices used in laparoscopic surgery is usually more serious. Ureteral injuries are known complication of gynecologic surgery. Injury to the distal right ureter was suspected and then confirmed by this study. The lower ureter lies in close proximity 12 cm to he cervix and the lateral fornix of the vagina as it curves anteriorly to the bladder, at about 2 cm from the ureterovesicaljunction. To describe clinical presentation, etiology, and treatment of ureteral injuries recognized late in women who had gynecologic laparoscopies. Furthermore, damage could be caused by electrocautery, cryoablation, avulsion, or partial laceration or transection of the ureter.
Keep in mind that if the repair took place during another surgery, the codes may be bundled so be sure you check the cci edits. Ureteral reimplantation for inadvertent ureteral injury. Our client was a young mother who had a csection with her second child during the course of the surgery, her ureter. Once her doctors realize this, she correctly orders a urology consult during the procedure. Ureteric injury is a relatively uncommon, but severe event, which may result in serious complications as a diagnosis is often delayed. Ureteric injury post cesarean section radiology case. Overview of traumatic and iatrogenic ureteral injury. Coding companion for urologynephrology evaluation and management 403 evaluation and management evaluation and. Injury to the ureter is one of the most serious complications of gynecologic surgery. Iatrogenic ureteral injuries arise as serious complication following obstetrics, gynecological, general, and urological surgery with incidence in the range of 0. When they occur, the majority of traumatic ureteral injuries are due to a penetrating mechanism, predominantly in young males. Late presentation of ureteral injury after laparoscopic. Identifying and avoiding ureteral injury clinical gate. Ureteral injuries medical malpractice attorneys boston ma dr.
Sometimes, retrograde urography an xray taken after a radiopaque contrast agent is instilled directly into the end of the ureter is done, usually during cystoscopy passing a flexible viewing tube through the urethra into the bladder. The missile path even close to the ureter can cause signi. A free powerpoint ppt presentation displayed as a flash slide show on id. Differences in surgical indication could also contribute to the increased incidence of ureteral injury among laparoscopic procedures. Preoperative evaluation is useful in identifying patients who are at higher risk of ureteral injury, although it has been reported that half of all patients with ureteral injuries have no risk factors. However, a missed ureteral injury can result in significant morbidity and mortality. Ureter, injury, iatrogenic, hysterectomy, reimplantation. Powerpoint is the worlds most popular presentation software which can let you create professional burn injuries powerpoint presentation easily and in no time. Major intraabdominal injuries were often associated, but hematuria and hypotension were not consistent findings 75%.
Bladder and ureter injured during hysterectomy clinician. Retrograde pyelography rpg is the most sensitive radiographic study for the diagnosis of ureteral injury. We report the unusual case of 42yearold woman who had a delayed diagnosis of bilateral ureteral injury associated with bladder lesion and loose of vaginal suture after undergoing laparoscopic hysterectomy for uterine adenomyosis. Ureteral trauma is rare, accounting for less than 1% of all urologic traumas. Ppt ureteral injuries in gynecologic surgery powerpoint.
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